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General NPI Number Information
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NPI Number | 1659628758
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Entity Type | Organization
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Legal Business Name | ROBERT A. MECUM, M.D., INC.
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Dates
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Enumeration Date | 08/07/2012
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Last Update Date | 04/22/2013
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Provider Practice Location Address
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Address Line | 1605 EUSTON RD
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City | SAN MARINO
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State | CA
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Zip | 91108-1917
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Country | US
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Telephone | 562-789-5577
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Fax | 562-789-5567
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Provider Business Mailing Address
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Address Line | 12291 WASHINGTON BLVD STE 304
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City | WHITTIER
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State | CA
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Zip | 90606-2551
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Country | US
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Telephone | 562-789-5577
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Fax | 562-789-5567
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. ROBERT A MECUM
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Credential | M.D.
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Telephone | 562-789-5577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | G78258
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License Number State | CA
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