Provider Demographics
NPI:1053311274
Name:GHAUSSY, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:GHAUSSY
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 1:3180 WILLOW LN
Mailing Address - Street 2:#200
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4941
Mailing Address - Country:US
Mailing Address - Phone:805-497-3239
Mailing Address - Fax:805-497-3110
Practice Address - Street 1:3180 WILLOW LN
Practice Address - Street 2:#200
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91361-4941
Practice Address - Country:US
Practice Address - Phone:805-497-3239
Practice Address - Fax:805-497-3110
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA39905174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA88504Medicare UPIN