Healthcare Provider Details

I. General information

NPI: 1730490145
Provider Name (Legal Business Name): ROBERT W. FOSTER, MD, A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2010
Last Update Date: 06/30/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5565 GROSSMONT CENTER DR STE 105
LA MESA CA
91942-3021
US

IV. Provider business mailing address

5565 GROSSMONT CENTER DR. STE 105
LA MESA CA
91942-6102
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-9600
  • Fax: 619-461-0334
Mailing address:
  • Phone: 619-461-9600
  • Fax: 619-461-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG56132
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT W FOSTER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-461-9600