=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417240862
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBERT S IMPROTA MD, A MEDICAL CORP
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/18/2011
-----------------------------------------------------
Last Update Date | 05/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2460 N PONDEROSA DR # A117
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-2398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-484-2855
-----------------------------------------------------
Fax | 805-389-1245
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2460 N PONDEROSA DR # A117
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93010-2398
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-484-2855
-----------------------------------------------------
Fax | 805-389-1245
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | ROBERT S IMPROTA
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 805-484-2855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208200000X
-----------------------------------------------------
Taxonomy Name | Plastic Surgery Physician
-----------------------------------------------------
License Number | G19368
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------