Provider Demographics
NPI:1982810883
Name:PIERCE, ROBYN MARIE (IDC)
Entity type:Individual
Prefix:MS
First Name:ROBYN
Middle Name:MARIE
Last Name:PIERCE
Suffix:
Gender:F
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS RUSHMORE LSD 47
Mailing Address - Street 2:MEDICAL DEPARTMENT
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96677
Mailing Address - Country:US
Mailing Address - Phone:619-556-3820
Mailing Address - Fax:
Practice Address - Street 1:4417 MOUNT EVEREST BLVD
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-4806
Practice Address - Country:US
Practice Address - Phone:858-560-1541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman