1306903687 NPI number — ROBERT F OLDT MD INC

Table of content: (NPI 1306903687)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306903687 NPI number — ROBERT F OLDT MD INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT F OLDT MD 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:
6
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:
1306903687
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1555 W 5TH ST STE 180
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OXNARD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93030-6563
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-985-5599
Provider Business Mailing Address Fax Number:
805-985-2867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1555 W 5TH ST STE 180
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OXNARD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93030-6563
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-985-5599
Provider Business Practice Location Address Fax Number:
805-985-2867
Provider Enumeration Date:
01/03/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLDT
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
805-985-5599

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , 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: GR0087750 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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