Healthcare Provider Details

I. General information

NPI: 1346376555
Provider Name (Legal Business Name): ROBERT FRANCIS MIHALIK NP, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/24/2007
Last Update Date: 04/11/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2460 BLUE JAY DR
SAN DIEGO CA
92123-3310
US

IV. Provider business mailing address

2460 BLUE JAY DR
SAN DIEGO CA
92123-3310
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-1263
  • Fax: 858-278-1263
Mailing address:
  • Phone: 858-278-1263
  • Fax: 858-278-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1004104
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3918
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: