MEDICARE: CALIFORNIA EAR INSTITUTE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	G65997	CA
2	174400000X	Specialist	C24575	CA
3	174400000X	Specialist	A53869	CA

General Provider Information

NPI Number	:	1073611406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALIFORNIA EAR INSTITUTE, INC.

Provider Business Mailing Address
First Line	:	1900 UNIVERSITY AVE
Second Line	:	SUITE 101
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-2213
Country	:	US
Telephone Number	:	650-494-1000
Fax Number	:	650-322-8228

Provider Business Practice Location Address
First Line	:	1900 UNIVERSITY AVE
Second Line	:	SUITE 101
City	:	EAST PALO ALTO
State	:	CA
Zip	:	94303-2213
Country	:	US
Telephone Number	:	650-494-1000
Fax Number	:	650-322-8228

Authorized Official
Title or Position	:	CEO
Name	:	JOSEPH BAXTER ROBERSON JR.
Credential	:	MD
Telephone Number	:	650-462-3149

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/15/2011

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Directions to “CALIFORNIA EAR INSTITUTE, INC. ” Practice Location

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