Healthcare Provider Details

I. General information

NPI: 1013178102
Provider Name (Legal Business Name): ROBERT KOZLOWSKI MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2008
Last Update Date: 12/16/2019
Certification Date: 12/16/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25751 MCBEAN PKWY STE 210
VALENCIA CA
91355-3701
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 661-284-3100
  • Fax: 661-290-3310
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA126369
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: