Healthcare Provider Details

I. General information

NPI: 1043256316
Provider Name (Legal Business Name): DR. ROBERT W EITCHES
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 11/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8631 W 3RD ST 925E
LOS ANGELES CA
90048-5901
US

IV. Provider business mailing address

8631 W 3RD ST 925E
LOS ANGELES CA
90048-5901
US

V. Phone/Fax

Practice location:
  • Phone: 310-657-4600
  • Fax: 310-657-6020
Mailing address:
  • Phone: 310-657-4600
  • Fax: 310-657-6020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License NumberG44618
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: