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General NPI Number Information
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NPI Number | 1639247216
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Entity Type | Organization
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Legal Business Name | ROBERT J. KOLESNIK M.D., INC.
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Dates
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Enumeration Date | 12/01/2006
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Last Update Date | 06/21/2018
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Provider Practice Location Address
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Address Line | 1230 E ARROW HWY
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City | UPLAND
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State | CA
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Zip | 91786-4910
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Country | US
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Telephone | 909-920-0298
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Fax | 909-985-9227
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Provider Business Mailing Address
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Address Line | 1230 E ARROW HWY
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City | UPLAND
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State | CA
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Zip | 91786-4910
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Country | US
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Telephone | 909-920-0298
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Fax | 909-985-9227
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT JAMES KOLESNIK
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Credential | MD
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Telephone | 909-920-0298
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G44386
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License Number State | CA
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