Provider Demographics
NPI:1417008632
Name:ROBERT B HOSSEINI M D INC
Entity Type:Organization
Organization Name:ROBERT B HOSSEINI M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:B
Authorized Official - Last Name:HOSSEINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-540-7200
Mailing Address - Street 1:1728 S CATALINA AVE
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-5517
Mailing Address - Country:US
Mailing Address - Phone:310-540-7200
Mailing Address - Fax:310-540-5455
Practice Address - Street 1:1728 S CATALINA AVE
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90277-5504
Practice Address - Country:US
Practice Address - Phone:310-540-7200
Practice Address - Fax:310-540-5455
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63298207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty