Provider Demographics
NPI:1225417843
Name:ROBERT KOLLMORGEN DO INC
Entity Type:Organization
Organization Name:ROBERT KOLLMORGEN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLLMORGEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:951-698-4660
Mailing Address - Street 1:25150 HANCOCK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-5987
Mailing Address - Country:US
Mailing Address - Phone:951-698-4660
Mailing Address - Fax:951-698-4659
Practice Address - Street 1:25150 HANCOCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5987
Practice Address - Country:US
Practice Address - Phone:951-698-4660
Practice Address - Fax:951-698-4659
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-28
Last Update Date:2015-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A11956207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty