=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861429060
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ROBERT MARC POUSMAN DO
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/26/2006
-----------------------------------------------------
Last Update Date | 02/28/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6815 NOBLE AVE STE#400
-----------------------------------------------------
City | VAN NUYS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91405-3796
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-901-6690
-----------------------------------------------------
Fax | 818-901-6699
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 20612 PACIFIC COAST HWY
-----------------------------------------------------
City | MALIBU
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90265-5403
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-774-6472
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number | 20A9252
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207LC0200X
-----------------------------------------------------
Taxonomy Name | Critical Care Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 20A9252
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | 20A9252
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------