Basic Information
| Provider Information | |||||||||
| NPI: | 1083095111 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBENIOL | ||||||||
| FirstName: | DON | ||||||||
| MiddleName: | RAFAEL | ||||||||
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| Credential: | MSN, RN, PMHNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1955 LONG BEACH BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624376717 | ||||||||
| FaxNumber: | 5624375072 | ||||||||
| Practice Location | |||||||||
| Address1: | 1955 LONG BEACH BLVD STE 200 | ||||||||
| Address2: | |||||||||
| City: | LONG BEACH | ||||||||
| State: | CA | ||||||||
| PostalCode: | 908065501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5624376717 | ||||||||
| FaxNumber: | 5624375072 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2015 | ||||||||
| LastUpdateDate: | 09/13/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/13/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0808X | 95015157 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 163W00000X | 95022472 | CA | N | Nursing Service Providers | Registered Nurse | 390200000X | 95022472 | CA | N | Student, Health Care | Student in an Organized Health Care Education/Training Program | 163WC0400X | 95022472 | CA | N | Nursing Service Providers | Registered Nurse | Case Management | 163WR0400X | 95022472 | CA | N | Nursing Service Providers | Registered Nurse | Rehabilitation |
No ID Information.