Provider Demographics
NPI:1033219084
Name:LADINES, ROBERT E (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:E
Last Name:LADINES
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1180 LIDA ST
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-2333
Mailing Address - Country:US
Mailing Address - Phone:626-792-7587
Mailing Address - Fax:909-620-8817
Practice Address - Street 1:1515 N FAIR OAKS AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91103-1808
Practice Address - Country:US
Practice Address - Phone:626-798-1111
Practice Address - Fax:626-345-1901
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-22
Last Update Date:2010-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51126207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A511260Medicaid
CAA51126Medicare PIN
CAF90736Medicare UPIN