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NPI Code Detail

MEDICARE: ROBERT A. CHERNOFF PH.D

MEDICARE: ROBERT A. CHERNOFF PH.D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical PsychologistPSY18519CA

General Provider Information

NPI Number : 1255302436
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROBERT A. CHERNOFF PH.D
Provider Business Mailing Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number : 310-751-5295
Provider Business Practice Location Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number : 310-751-5295
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/27/2006
Last Update Date : 09/20/2012

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