Healthcare Provider Details

I. General information

NPI: 1821014820
Provider Name (Legal Business Name): ROBERT B EISENBERG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2006
Last Update Date: 03/13/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1541 FLORIDA AVE #100
MODESTO CA
95350-4429
US

IV. Provider business mailing address

8851 CENTER DR #501
LA MESA CA
91942-3017
US

V. Phone/Fax

Practice location:
  • Phone: 209-577-3388
  • Fax: 209-338-0024
Mailing address:
  • Phone: 619-697-2456
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberA31900
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: