Healthcare Provider Details

I. General information

NPI: 1235147638
Provider Name (Legal Business Name): ROBERT M KRASNY MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 04/19/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 SANTA MONICA BLVD SUITE 206
SANTA MONICA CA
90404-2095
US

IV. Provider business mailing address

2336 SANTA MONICA BLVD SUITE 206
SANTA MONICA CA
90404-2095
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-7226
  • Fax: 310-828-4426
Mailing address:
  • Phone: 310-828-7226
  • Fax: 310-828-4426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberG69870
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberG69870
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: