Provider Demographics
NPI:1336330745
Name:ROBERT W. OBLATH, M.D., INC.
Entity Type:Organization
Organization Name:ROBERT W. OBLATH, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JAMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-774-1771
Mailing Address - Street 1:PO BOX 572913
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-2913
Mailing Address - Country:US
Mailing Address - Phone:818-774-1771
Mailing Address - Fax:818-704-4977
Practice Address - Street 1:18370 BURBANK BLVD
Practice Address - Street 2:#607
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-2804
Practice Address - Country:US
Practice Address - Phone:818-774-1771
Practice Address - Fax:818-704-4977
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-09
Last Update Date:2012-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39082261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CADE8050OtherMEDICARE RAILROAD
CA00G390820Medicaid
CAWG39082EOtherMEDICARE ID
CA00G390820Medicaid