Provider Demographics
NPI:1265638373
Name:HAAG, ROBERT JOSEPH (702177)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JOSEPH
Last Name:HAAG
Suffix:
Gender:M
Credentials:702177
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11429 MIRO CIR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-3316
Mailing Address - Country:US
Mailing Address - Phone:858-397-2309
Mailing Address - Fax:
Practice Address - Street 1:11429 MIRO CIR
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-3316
Practice Address - Country:US
Practice Address - Phone:858-397-2309
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-25
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA3779367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered