Provider Demographics
NPI:1023239209
Name:GAFFKE VILLAVICENCIO, ROBIN STACI (BA, ATC)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:STACI
Last Name:GAFFKE VILLAVICENCIO
Suffix:
Gender:F
Credentials:BA, ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1533 2ND AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401
Mailing Address - Country:US
Mailing Address - Phone:650-348-0505
Mailing Address - Fax:
Practice Address - Street 1:1533 2ND AVENUE
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401
Practice Address - Country:US
Practice Address - Phone:650-348-0505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer