Healthcare Provider Details

I. General information

NPI: 1568401388
Provider Name (Legal Business Name): ROBERT JAY MARGOLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19191 S VERMONT AVE 200
TORRANCE CA
90502-1018
US

IV. Provider business mailing address

19191 S VERMONT AVE 200
TORRANCE CA
90502-1018
US

V. Phone/Fax

Practice location:
  • Phone: 310-354-4221
  • Fax: 310-538-0671
Mailing address:
  • Phone: 310-354-4221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG28020
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: