Healthcare Provider Details

I. General information

NPI: 1770041881
Provider Name (Legal Business Name): ROBOTIC BRAIN AND SPINE INSTITUTE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9201 W SUNSET BLVD STE 405
LOS ANGELES CA
90069-3705
US

IV. Provider business mailing address

9201 W SUNSET BLVD STE 405
LOS ANGELES CA
90069-3705
US

V. Phone/Fax

Practice location:
  • Phone: 310-887-1730
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: RICHARD MATLOCK
Title or Position: COO
Credential:
Phone: 310-887-1730