Provider Demographics
NPI:1245264720
Name:HUIZENGA, ROBERT JOHN (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOHN
Last Name:HUIZENGA
Suffix:
Gender:M
Credentials:MD
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Other - First Name:
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Mailing Address - Street 1:150 N ROBERTSON BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-2144
Mailing Address - Country:US
Mailing Address - Phone:310-657-9191
Mailing Address - Fax:310-657-9088
Practice Address - Street 1:150 N ROBERTSON BOULEVARD
Practice Address - Street 2:SUITE 115
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-2144
Practice Address - Country:US
Practice Address - Phone:310-657-9191
Practice Address - Fax:310-657-9088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-10
Last Update Date:2015-08-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAG40228207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA48179Medicare UPIN