Healthcare Provider Details

I. General information

NPI: 1780628487
Provider Name (Legal Business Name): ROBERT ASHLEY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/20/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1260 15TH ST 1501
SANTA MONICA CA
90404-1135
US

IV. Provider business mailing address

5767 W CENTURY BLVD 400
LOS ANGELES CA
90045-5631
US

V. Phone/Fax

Practice location:
  • Phone: 310-656-1700
  • Fax:
Mailing address:
  • Phone: 310-656-1701
  • Fax: 310-451-0931

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA66332
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: