Provider Demographics
NPI:1376521005
Name:DORIA, ROBERT J (MD, FACC)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:J
Last Name:DORIA
Suffix:
Gender:M
Credentials:MD, FACC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1941 JOHNSON AVE
Mailing Address - Street 2:# 101
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4154
Mailing Address - Country:US
Mailing Address - Phone:805-782-8844
Mailing Address - Fax:833-613-2634
Practice Address - Street 1:1941 JOHNSON AVE
Practice Address - Street 2:# 101
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4154
Practice Address - Country:US
Practice Address - Phone:805-782-8844
Practice Address - Fax:833-613-2634
Is Sole Proprietor?:No
Enumeration Date:2006-01-03
Last Update Date:2023-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54180207RC0000X, 207RI0011X, 207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA110039995OtherRR MEDICARE
CAZZZ28458ZOtherBLUE SHIELD
CA00G541800Medicaid
CAWG54180DMedicare PIN
CA00G541800Medicaid
CAE02747Medicare UPIN
CAZZZ28458ZOtherBLUE SHIELD
CAWG54180FMedicare PIN
CAWG54180LMedicare PIN
CA00G541800Medicaid
CAWG54180EMedicare PIN
CAWG54180KMedicare PIN
CAWG54180BMedicare PIN