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NPI Code Detail

MEDICARE: ROBERTO DATILES RPH

MEDICARE: ROBERTO DATILES RPH
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
1183500000XPharmacistPH60120621WA
21835G0303XGeriatric Pharmacist66710CA
3183500000XPharmacist66710CA

General Provider Information

NPI Number : 1659795342
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERTO DATILES RPH
Provider Business Mailing Address
First Line : 7865 STARLING DR
Second Line :
City : SAN DIEGO
State : CA
Zip : 92123-2747
Country : US
Telephone Number : 619-665-9271
Fax Number :
Provider Business Practice Location Address
First Line : 215 N 2ND ST
Second Line :
City : EL CAJON
State : CA
Zip : 92021-7243
Country : US
Telephone Number : 619-401-0761
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/14/2014
Last Update Date : 04/04/2020

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Directions to “ ROBERTO DATILES RPH” Practice Location

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