Provider Demographics
NPI:1730193996
Name:RESNIKOFF, JOSEPH ROBERT (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:ROBERT
Last Name:RESNIKOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 WASHINGTON ST SUITE 501
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2294
Mailing Address - Country:US
Mailing Address - Phone:619-299-2570
Mailing Address - Fax:619-294-2738
Practice Address - Street 1:501 WASHINGTON ST STE 508
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2231
Practice Address - Country:US
Practice Address - Phone:619-299-2570
Practice Address - Fax:619-294-2738
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2015-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81283207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G812830Medicaid
CA00G812830Medicaid
CAG81283Medicare ID - Type Unspecified