Healthcare Provider Details

I. General information

NPI: 1730881228
Provider Name (Legal Business Name): ROBERT SARORN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2023
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17732 BEACH BLVD STE G
HUNTINGTON BEACH CA
92647-6881
US

IV. Provider business mailing address

6410 ORIZABA AVE
LONG BEACH CA
90805-3334
US

V. Phone/Fax

Practice location:
  • Phone: 714-655-7142
  • Fax: 833-224-5825
Mailing address:
  • Phone: 562-753-1384
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: