Provider Demographics
NPI:1083625784
Name:ROBERT S DOOMUN D.O., INC.
Entity Type:Organization
Organization Name:ROBERT S DOOMUN D.O., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:SEAN
Authorized Official - Last Name:DOOMUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:714-777-3606
Mailing Address - Street 1:19871 YORBA LINDA BLVD
Mailing Address - Street 2:SUITE #104
Mailing Address - City:YORBA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92886-2811
Mailing Address - Country:US
Mailing Address - Phone:714-777-3606
Mailing Address - Fax:714-777-3664
Practice Address - Street 1:19871 YORBA LINDA BLVD
Practice Address - Street 2:SUITE #104
Practice Address - City:YORBA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92886-2811
Practice Address - Country:US
Practice Address - Phone:714-777-3606
Practice Address - Fax:714-777-3664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A7459207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH76479Medicare UPIN