Healthcare Provider Details

I. General information

NPI: 1558360164
Provider Name (Legal Business Name): ROBERT M HARTMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT M HARTMAN M.D.

II. Dates (important events)

Enumeration Date: 07/15/2005
Last Update Date: 01/19/2024
Certification Date: 01/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5400 BALBOA BLVD SUITE 329
ENCINO CA
91316-5246
US

IV. Provider business mailing address

PO BOX 6971
LINCOLN NE
68506-0971
US

V. Phone/Fax

Practice location:
  • Phone: 818-907-7076
  • Fax: 818-907-7044
Mailing address:
  • Phone: 818-907-7076
  • Fax: 402-434-6047

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG52939
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: