Healthcare Provider Details

I. General information

NPI: 1538267091
Provider Name (Legal Business Name): CALIFORNIA EAR INSTITUTE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 08/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 UNIVERSITY AVE SUITE 101
E PALO ALTO CA
94303-2212
US

IV. Provider business mailing address

1900 UNIVERSITY AVE SUITE 101
E PALO ALTO CA
94303-2212
US

V. Phone/Fax

Practice location:
  • Phone: 650-462-3149
  • Fax: 650-433-5448
Mailing address:
  • Phone: 650-462-3149
  • Fax: 650-323-7148

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number00G778090
License Number StateCA

VIII. Authorized Official

Name: JOSEPH BAXTER ROBERSON JR.
Title or Position: CEO
Credential: M.D.
Phone: 650-462-3149