Healthcare Provider Details

I. General information

NPI: 1407476724
Provider Name (Legal Business Name): ROBERT SCIULLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/17/2020
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1201 W LA VETA AVE
ORANGE CA
92868-4203
US

IV. Provider business mailing address

31 E MACARTHUR CRES APT E519
SANTA ANA CA
92707-5969
US

V. Phone/Fax

Practice location:
  • Phone: 714-509-8155
  • Fax:
Mailing address:
  • Phone: 949-874-7627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License NumberA207909
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: