1831360288 NPI number — ROBERT B. SELTZER, M.D., INC.

Table of content: (NPI 1831360288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831360288 NPI number — ROBERT B. SELTZER, M.D., INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT B. SELTZER, M.D., INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831360288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
960 E GREEN ST
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91106-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-449-3830
Provider Business Mailing Address Fax Number:
626-584-6532

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
960 E GREEN ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
PASADENA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91106-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-449-3830
Provider Business Practice Location Address Fax Number:
626-584-6532
Provider Enumeration Date:
03/13/2008

Additional Information

Authorized Official

Authorized Official Last Name:
RAMIREZ
Authorized Official First Name:
MARILU
Authorized Official Middle Name:
Authorized Official Title or Position:
BUSINESS OFFICE SUPERVISOR
Authorized Official Telephone Number:
626-449-3830

Provider Taxonomy Codes

  • Taxonomy code: 305R00000X , with the licence number:  G30649 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1437127099 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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