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General NPI Number Information
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NPI Number | 1215157326
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Entity Type | Individual
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Provider Name | ROBERT MICHAEL JEFFRIES C.O.
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Gender | Male
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Dates
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Enumeration Date | 04/30/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 444 S SAN VICENTE BLVD MGB, SUITE 603
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City | LOS ANGELES
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State | CA
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Zip | 90048-4165
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Country | US
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Telephone | 310-313-5874
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Fax | 310-395-1187
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Provider Business Mailing Address
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Address Line | PO BOX 3698
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City | SANTA MONICA
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State | CA
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Zip | 90408-3698
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Country | US
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Telephone | 310-313-5874
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Fax | 310-395-1187
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BC3200X
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Taxonomy Name | Customized Equipment (DME)
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License Number |
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License Number State |
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