Healthcare Provider Details

I. General information

NPI: 1326030669
Provider Name (Legal Business Name): ROBERT J SEMO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2005
Last Update Date: 07/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 LA JOLLA VILLAGE DR
SAN DIEGO CA
92161-0002
US

IV. Provider business mailing address

200 W ARBOR DR MC 8433
SAN DIEGO CA
92103-9000
US

V. Phone/Fax

Practice location:
  • Phone: 858-552-8585
  • Fax: 858-552-8585
Mailing address:
  • Phone: 619-543-6906
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberA42951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: