1962470161 NPI number — ROBERT PARKE M.D.

Table of content: ROBERT PARKE M.D. (NPI 1962470161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962470161 NPI number — ROBERT PARKE M.D.

Organization/Personal Information

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

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:
1962470161
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
845 W LA VETA AVE STE 108
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92868-3930
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
714-639-2600
Provider Business Mailing Address Fax Number:
714-289-3906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
845 W LA VETA AVE STE 108
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORANGE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92868
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-639-2600
Provider Business Practice Location Address Fax Number:
714-289-3906
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X , with the licence number:  G27430 , 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: CG5665 . This is a "RAIL ROAD MEDICARE - GROUP PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 290003379 . This is a "RAIL ROAD MEDICARE - PROVIDER PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W1514B . This is a "MEDICARE PTAN - TYPE 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W11996 . This is a "MEDICARE PTAN - TYPE 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 1447410519 . This is a "NPI - TYPE 2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1720247455 . This is a "NPI - TYPE 2" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1912919804 . This is a "NPI - TYPE 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: W1514 . This is a "MEDICARE PTAN - TYPE 2" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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