Healthcare Provider Details

I. General information

NPI: 1699294074
Provider Name (Legal Business Name): ROBERT ERIC BOOKSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2017
Last Update Date: 09/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD.
LOS ANGELES CA
90048
US

IV. Provider business mailing address

8956 LA JOLLA SCENIC DR N
LA JOLLA CA
92037-1609
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-3277
  • Fax:
Mailing address:
  • Phone: 858-736-6581
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207ZP0007X
TaxonomyMolecular Genetic Pathology (Pathology) Physician
License NumberG56957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: