Healthcare Provider Details

I. General information

NPI: 1467401844
Provider Name (Legal Business Name): ROBERT ELLIOTT M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2006
Last Update Date: 01/24/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2710 W MANCHESTER BLVD
INGLEWOOD CA
90305-2436
US

IV. Provider business mailing address

2710 W MANCHESTER BLVD
INGLEWOOD CA
90305-2436
US

V. Phone/Fax

Practice location:
  • Phone: 323-778-4310
  • Fax: 323-778-0838
Mailing address:
  • Phone: 323-778-4310
  • Fax: 323-778-0838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG38036
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: