Healthcare Provider Details

I. General information

NPI: 1538336581
Provider Name (Legal Business Name): ROBERT JAMES PRESTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 03/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2051 MARENGO ST DIVISION OF TRAUMA AND CRITICAL CARE USC
LOS ANGELES CA
90033-1352
US

IV. Provider business mailing address

PO BOX 31309
LOS ANGELES CA
90031-0309
US

V. Phone/Fax

Practice location:
  • Phone: 323-865-1241
  • Fax:
Mailing address:
  • Phone: 323-865-1241
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number128134
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code2086S0127X
TaxonomyTrauma Surgery Physician
License NumberC134885
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: