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General NPI Number Information
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NPI Number | 1477854123
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Entity Type | Organization
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Legal Business Name | ROBERT S. HERRICK M.D. INC
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Dates
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Enumeration Date | 11/11/2010
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Last Update Date | 12/07/2011
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Provider Practice Location Address
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Address Line | 882 W RIALTO AVE
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City | RIALTO
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State | CA
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Zip | 92376-5658
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Country | US
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Telephone | 909-820-4051
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Fax | 909-820-4053
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Provider Business Mailing Address
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Address Line | 882 W RIALTO AVE
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City | RIALTO
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State | CA
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Zip | 92376-5658
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Country | US
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Telephone | 909-820-4051
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Fax | 909-820-4053
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Authorized Official
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Title or Position | OPHTHALMOGIST
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Name | DR. ROBERT STUART HERRICK
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Credential | M.D.
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Telephone | 909-820-4051
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | C24395
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License Number State | CA
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