Provider Demographics
NPI:1174652465
Name:ZYLSTRA, ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ZYLSTRA
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 1:2495 GLEN ALBYN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105
Mailing Address - Country:US
Mailing Address - Phone:805-682-0414
Mailing Address - Fax:805-524-0658
Practice Address - Street 1:2495 GLEN ALBYN DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105
Practice Address - Country:US
Practice Address - Phone:805-682-0414
Practice Address - Fax:805-524-0658
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2023-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG36944207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NPI 1174652465OtherPERSONAL NPI
CAG36944OtherLICENSE
NPI 1174652465OtherPERSONAL NPI
CAA91838Medicare UPIN
NPI 1174652465OtherPERSONAL NPI
CAW1509Medicare ID - Type UnspecifiedGROUP NUMBER