Basic Information
| Provider Information | |||||||||
| NPI: | 1346592227 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MERCER | ||||||||
| FirstName: | ROBIN | ||||||||
| MiddleName: | F | ||||||||
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| Credential: | PA | ||||||||
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| OtherLastName: | FUESSENICH | ||||||||
| OtherFirstName: | ROBIN | ||||||||
| OtherMiddleName: | F | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4000 DUBLIN BLVD | ||||||||
| Address2: | #100 | ||||||||
| City: | DUBLIN | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945683113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9255567320 | ||||||||
| FaxNumber: | 9254790231 | ||||||||
| Practice Location | |||||||||
| Address1: | 200 PORTER DR | ||||||||
| Address2: | SUITE 215 | ||||||||
| City: | SAN RAMON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945831587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9253622166 | ||||||||
| FaxNumber: | 8555743055 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2012 | ||||||||
| LastUpdateDate: | 05/11/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AS0400X | PA22528 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Surgical |
ID Information
| ID | Type | State | Issuer | Description | 22528 | 01 | CA | MEDICAL LICENSE | OTHER |