Healthcare Provider Details

I. General information

NPI: 1689763724
Provider Name (Legal Business Name): ROBERT L NEILAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: ROBERT LOWRY NEILAN M.D.

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 03/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17360 BROOKHURST ST
FOUNTAIN VALLEY CA
92708-3720
US

IV. Provider business mailing address

17360 BROOKHURST STREEET ATTN: CREDENTIALING DEPARTMENT
FOUNTAIN VALLEY CA
92708-3720
US

V. Phone/Fax

Practice location:
  • Phone: 949-340-9530
  • Fax: 714-665-4614
Mailing address:
  • Phone: 657-241-3592
  • Fax: 714-665-4614

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA70376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: