Provider Demographics
NPI:1730149006
Name:DYLESKI, ROBIN ANN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:ANN
Last Name:DYLESKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:DYLESKI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11370 ANDERSON STRET
Mailing Address - Street 2:SUITE 2100
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4201
Mailing Address - Country:US
Mailing Address - Phone:909-558-4000
Mailing Address - Fax:
Practice Address - Street 1:11370 ANDERSON ST STE 2100
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3450
Practice Address - Country:US
Practice Address - Phone:909-558-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2017-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY235194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01772325Medicaid
NY01772325Medicaid
NYG02715Medicare UPIN