Healthcare Provider Details

I. General information

NPI: 1770441834
Provider Name (Legal Business Name): MR. ROBERT SPEAKS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16712 RAMONA AVE
FONTANA CA
92336-2009
US

IV. Provider business mailing address

PO BOX 441
RANCHO CUCAMONGA CA
91729-0441
US

V. Phone/Fax

Practice location:
  • Phone: 909-559-4977
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95038136
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: