Provider Demographics
NPI:1659588168
Name:WIEGAND, ROBERT S
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:WIEGAND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 LA RAMADA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-1822
Mailing Address - Country:US
Mailing Address - Phone:626-447-4477
Mailing Address - Fax:626-355-6962
Practice Address - Street 1:1630 LA RAMADA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-1822
Practice Address - Country:US
Practice Address - Phone:626-447-4477
Practice Address - Fax:626-355-6962
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARHT 21079247100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247100000XTechnologists, Technicians & Other Technical Service ProvidersRadiologic Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ20842ZMedicare ID - Type UnspecifiedULTRASOUND