Provider Demographics
NPI:1689928731
Name:TRAUTMAN, ROBERT S (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:S
Last Name:TRAUTMAN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15840 THOMAS PAINE DR
Mailing Address - Street 2:
Mailing Address - City:RAMONA
Mailing Address - State:CA
Mailing Address - Zip Code:92065-7330
Mailing Address - Country:US
Mailing Address - Phone:760-788-6910
Mailing Address - Fax:
Practice Address - Street 1:13589 POWAY RD
Practice Address - Street 2:
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-4715
Practice Address - Country:US
Practice Address - Phone:858-486-9995
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-27
Last Update Date:2012-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54942183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA54942OtherSTATE LICENSE