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General NPI Number Information
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NPI Number | 1497145213
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Entity Type | Organization
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Legal Business Name | ROBERT CARROLL MD A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 02/01/2015
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 1314 WESTWOOD BLVD #210
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-475-2990
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Fax |
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Provider Business Mailing Address
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Address Line | 1314 WESTWOOD BLVD #210
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City | LOS ANGELES
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State | CA
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Zip | 90024
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Country | US
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Telephone | 310-475-2990
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT S. CARROLL
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Credential | MD
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Telephone | 310-475-2990
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | G32317
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number |
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License Number State |
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