Healthcare Provider Details

I. General information

NPI: 1659353977
Provider Name (Legal Business Name): ROBERT C O'BOYLE MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/14/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NAVAL CLINIC, PEDIATRICS 162 FIRST STREET
PORT HUENEME CA
93043-0001
US

IV. Provider business mailing address

5905 LAKE LINDERO DR
AGOURA HILLS CA
91301-1417
US

V. Phone/Fax

Practice location:
  • Phone: 805-982-6342
  • Fax:
Mailing address:
  • Phone: 818-991-2788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA43286
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: