Provider Demographics
NPI:1437172210
Name:INNOCENZI, ROBERT A (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:INNOCENZI
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:13197 CENTRAL AVE
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-4178
Mailing Address - Country:US
Mailing Address - Phone:909-590-2073
Mailing Address - Fax:909-590-2457
Practice Address - Street 1:13197 CENTRAL AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-4178
Practice Address - Country:US
Practice Address - Phone:909-590-2073
Practice Address - Fax:909-590-2457
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-11-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A5773207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF59603Medicare UPIN