Provider Demographics
NPI:1073538476
Name:SOROSKY, ROBERT HALE (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:HALE
Last Name:SOROSKY
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 1:1330 SAN BERNARDINO RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-4928
Mailing Address - Country:US
Mailing Address - Phone:909-981-8985
Mailing Address - Fax:929-949-4550
Practice Address - Street 1:1330 SAN BERNARDINO RD
Practice Address - Street 2:SUITE C
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4928
Practice Address - Country:US
Practice Address - Phone:909-981-8985
Practice Address - Fax:929-949-4550
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11186174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G111860Medicare ID - Type Unspecified
CAA38261Medicare UPIN