Healthcare Provider Details

I. General information

NPI: 1326717588
Provider Name (Legal Business Name): ROBERT J JOSEPH DPM INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2021
Last Update Date: 09/10/2021
Certification Date: 09/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1510 S CENTRAL AVE
GLENDALE CA
91204-2500
US

IV. Provider business mailing address

17187 ROUNDHILL DR
HUNTINGTON BEACH CA
92649-4216
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-3668
  • Fax: 818-242-3668
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213EP1101X
TaxonomyPrimary Podiatric Medicine Podiatrist
License Number
License Number State

VIII. Authorized Official

Name: ROBERT JOSEPH
Title or Position: OWNER
Credential: DPM
Phone: 949-212-8675