Provider Demographics
NPI:1548457211
Name:ROBERT E NEVELN M.D. INC
Entity type:Organization
Organization Name:ROBERT E NEVELN M.D. INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:NEVELN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-452-7040
Mailing Address - Street 1:9850 GENESEE AVE STE 870
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1233
Mailing Address - Country:US
Mailing Address - Phone:858-452-7040
Mailing Address - Fax:858-452-7137
Practice Address - Street 1:9850 GENESEE AVE STE 870
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1233
Practice Address - Country:US
Practice Address - Phone:858-452-7040
Practice Address - Fax:858-452-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-26
Last Update Date:2007-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG040850207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA92213Medicare UPIN