Healthcare Provider Details

I. General information

NPI: 1235616871
Provider Name (Legal Business Name): ROBERT ALBERT WESTRA JR. RESPIRATORY CARE PRA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/26/2018
Last Update Date: 07/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

IV. Provider business mailing address

6640 ALTON PKWY
IRVINE CA
92618-3734
US

V. Phone/Fax

Practice location:
  • Phone: 949-932-6880
  • Fax: 949-932-6381
Mailing address:
  • Phone: 949-932-6880
  • Fax: 949-932-6381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code227900000X
TaxonomyRegistered Respiratory Therapist
License Number18825
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License Number4936
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: