Healthcare Provider Details

I. General information

NPI: 1205879798
Provider Name (Legal Business Name): ROBERT SHERMAN VINETZ M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 BIMINI PL
LOS ANGELES CA
90004-5903
US

IV. Provider business mailing address

1300 N VERMONT AVE SUITE 1002
LOS ANGELES CA
90027-6005
US

V. Phone/Fax

Practice location:
  • Phone: 213-387-2822
  • Fax: 213-385-8482
Mailing address:
  • Phone: 323-953-7341
  • Fax: 323-953-6244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG21262
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: