Provider Demographics
NPI:1235381781
Name:TRAFELI, ROBERT MARIO (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:MARIO
Last Name:TRAFELI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2128 PICO BLVD
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90405-1718
Mailing Address - Country:US
Mailing Address - Phone:310-722-0033
Mailing Address - Fax:
Practice Address - Street 1:2128 PICO BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-1718
Practice Address - Country:US
Practice Address - Phone:310-722-0033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A5618207Q00000X
UT5103325-1204207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine