Basic Information
Provider Information | |||||||||
NPI: | 1811570997 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | ROBINSON | ||||||||
FirstName: | MARIA | ||||||||
MiddleName: | LUPITA | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | HAD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | MARTINEZ | ||||||||
OtherFirstName: | MARIA | ||||||||
OtherMiddleName: | LUPITA | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 5555 GARDEN GROVE BLVD STE 200 | ||||||||
Address2: |   | ||||||||
City: | WESTMINSTER | ||||||||
State: | CA | ||||||||
PostalCode: | 926838234 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7148985732 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 19520 NORDHOFF ST STE 5 | ||||||||
Address2: |   | ||||||||
City: | NORTHRIDGE | ||||||||
State: | CA | ||||||||
PostalCode: | 913242451 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7148985732 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 05/05/2021 | ||||||||
LastUpdateDate: | 05/05/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 05/05/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 237700000X | HA8649 | CA | Y |   | Speech, Language and Hearing Service Providers | Hearing Instrument Specialist |   |
ID Information
ID | Type | State | Issuer | Description | 8649 | 01 | CA | SPEECH-LANGUAGE PATHOLOGY AND AUDIOLOGY AND HEARING AID DISPENSERS BOARD | OTHER |