Healthcare Provider Details

I. General information

NPI: 1982938247
Provider Name (Legal Business Name): ROBERT B. EISENBERG, M.D., INC.,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2009
Last Update Date: 04/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR SUITE 501
LA MESA CA
91942-3058
US

IV. Provider business mailing address

8851 CENTER DR SUITE 501
LA MESA CA
91942-3058
US

V. Phone/Fax

Practice location:
  • Phone: 619-697-2456
  • Fax: 619-697-2494
Mailing address:
  • Phone: 619-697-2456
  • Fax: 619-697-2494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA31900
License Number StateCA

VIII. Authorized Official

Name: ROBERT B. EISENBERG
Title or Position: PRESIDENT
Credential: M.D.
Phone: 619-697-2456