Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111N00000X | Chiropractor | 20369DC | CA |
N | 111NN1001X | Nutrition | 20369 | CA |
NPI | 1205919081 |
---|---|
Provider Name | Dr. Jay R. Robbins |
First Address | Covina, CA 91723-1923 |
Second Address | Covina, CA 91723-1923 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/10/2006 |
Last Update Date | 04/01/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
95-3394768 | TAX ID (01) | CA |
DC20369 | (02) | CA |