Healthcare Provider Details

I. General information

NPI: 1447463997
Provider Name (Legal Business Name): ROBERT JOHN SPALDING PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2007
Last Update Date: 11/09/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20790 MADRONA AVE
TORRANCE CA
90503-3777
US

IV. Provider business mailing address

20790 MADRONA AVE
TORRANCE CA
90503-3777
US

V. Phone/Fax

Practice location:
  • Phone: 310-781-2829
  • Fax: 310-781-2843
Mailing address:
  • Phone: 310-781-2829
  • Fax: 310-781-2843

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA14763
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: