Healthcare Provider Details

I. General information

NPI: 1407924137
Provider Name (Legal Business Name): ROBERT F. NEMEROFF, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 08/22/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 MANNING AVE
LOS ANGELES CA
90024-5813
US

IV. Provider business mailing address

9663 SANTA MONICA BLVD #556
BEVERLY HILLS CA
90210-4303
US

V. Phone/Fax

Practice location:
  • Phone: 310-441-0051
  • Fax: 310-441-0052
Mailing address:
  • Phone: 310-441-0051
  • Fax: 310-441-0052

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2082S0099X
TaxonomyPlastic Surgery Within the Head and Neck (Plastic Surgery) Physician
License NumberG66348
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG66348
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT F. NEMEROFF
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-441-0051