Healthcare Provider Details

I. General information

NPI: 1124035530
Provider Name (Legal Business Name): ROBERT T SHIMIZU MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 01/11/2026
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

930 DEWING AVE
LAFAYETTE CA
94549-4223
US

IV. Provider business mailing address

930 DEWING AVE
LAFAYETTE CA
94549-4223
US

V. Phone/Fax

Practice location:
  • Phone: 925-284-1800
  • Fax: 925-284-1235
Mailing address:
  • Phone: 925-284-1800
  • Fax: 925-284-1235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberC29804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: