Robertson, Kevin Clark

Robertson, Kevin Clark is an individual health care provider with primary practice located at 125 Eucalyptus Dr , El Segundo CA 90245-3839. He recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, which is considered as his primary health care specialty. Robertson, Kevin Clark can be contacted via phone (310) 322-4278.

Contact Information

Primary practice address
125 Eucalyptus Dr El Segundo CA 90245-3839
Phone: (310) 322-4278
Fax: (310) 322-6660
Website:
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Health care specialties

SpecialtyCodeLicense #State
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X PA17110 California

Profile Details

NPI number 1295955441
LBN Legal business name Robertson, Kevin Clark
Credentials Physician Assistant (PA)
Entity Individual
Sole proprietor 1 No
Enumeration date Apr 30th, 2007
Last updated Aug 14th, 2015 - about 11 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1295955441 NPPES
California Other PA17110 MEDICAL LICENSE

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