Provider Demographics
NPI:1063690238
Name:JENSEN, ROBERT A (CPO)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
Last Name:JENSEN
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6001 TELEGRAPH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1310
Mailing Address - Country:US
Mailing Address - Phone:510-658-2062
Mailing Address - Fax:510-658-7779
Practice Address - Street 1:6001 TELEGRAPH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1310
Practice Address - Country:US
Practice Address - Phone:510-658-2062
Practice Address - Fax:510-658-7779
Is Sole Proprietor?:No
Enumeration Date:2008-02-09
Last Update Date:2008-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CPO 955222Z00000X, 224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CPO 955OtherABC