Healthcare Provider Details

I. General information

NPI: 1336187525
Provider Name (Legal Business Name): ROBERT WALTER BAUMHEFNER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/02/2006
Last Update Date: 08/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11301 WILSHIRE BLVD
LOS ANGELES CA
90073-1003
US

IV. Provider business mailing address

9835 COLUMBUS AVE
NORTH HILLS CA
91343-2213
US

V. Phone/Fax

Practice location:
  • Phone: 310-268-3013
  • Fax: 310-268-4611
Mailing address:
  • Phone: 310-268-3013
  • Fax: 310-268-4611

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberG29620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: