Provider Demographics
NPI:1235166075
Name:VENICK, ROBERT SCOTT (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:SCOTT
Last Name:VENICK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-206-6134
Mailing Address - Fax:
Practice Address - Street 1:10833 LECONTE AVE
Practice Address - Street 2:12-441 MDCC
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-206-6134
Practice Address - Fax:310-206-0203
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2013-09-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA770782080P0206X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0206XAllopathic & Osteopathic PhysiciansPediatricsPediatric Gastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A770780Medicaid
AU961ZMedicare PIN
CA00A770780Medicaid