Healthcare Provider Details

I. General information

NPI: 1841620333
Provider Name (Legal Business Name): ROBERT CONTRERAS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/19/2013
Last Update Date: 02/14/2023
Certification Date: 02/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5326 E BEVERLY BLVD
LOS ANGELES CA
90022-2104
US

IV. Provider business mailing address

5326 E BEVERLY BLVD
LOS ANGELES CA
90022-2104
US

V. Phone/Fax

Practice location:
  • Phone: 323-727-7896
  • Fax: 323-727-0284
Mailing address:
  • Phone: 323-727-7896
  • Fax: 323-727-0284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744R1102X
TaxonomyResearch Study Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: