Healthcare Provider Details

I. General information

NPI: 1316078793
Provider Name (Legal Business Name): ROBERT MICHAEL HUTCHMAN, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 03/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19231 VICTORY BLVD SUITE 355N
RESEDA CA
91335-6308
US

IV. Provider business mailing address

19231 VICTORY BLVD SUITE 355N
RESEDA CA
91335-6308
US

V. Phone/Fax

Practice location:
  • Phone: 818-654-9700
  • Fax: 818-654-9600
Mailing address:
  • Phone: 818-654-9700
  • Fax: 818-654-9600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA85762
License Number StateCA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier00A857620
Identifier TypeOTHER
Identifier State
Identifier IssuerBLUE SHIELD

VIII. Authorized Official

Name: DR. ROBERT MICHAEL HUTCHMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 818-654-9700