Healthcare Provider Details

I. General information

NPI: 1841436706
Provider Name (Legal Business Name): ROBERT ERIC DINENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/25/2008
Last Update Date: 10/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9834 GENESEE AVE SUITE 125
LA JOLLA CA
92037-1223
US

IV. Provider business mailing address

9834 GENESEE AVE SUITE 125
LA JOLLA CA
92037-1223
US

V. Phone/Fax

Practice location:
  • Phone: 858-450-1212
  • Fax: 858-453-9271
Mailing address:
  • Phone: 858-450-1212
  • Fax: 858-453-9271

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA80408
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA80408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: