Provider Demographics
NPI:1790708576
Name:LUSTIG, ROBERT HOWARD (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:HOWARD
Last Name:LUSTIG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:513 PARNASSUS AVE # 0434
Mailing Address - Street 2:UCSF
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2205
Mailing Address - Country:US
Mailing Address - Phone:415-502-8672
Mailing Address - Fax:415-476-8214
Practice Address - Street 1:400 PARNASSUS AVE FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2202
Practice Address - Country:US
Practice Address - Phone:415-353-2813
Practice Address - Fax:415-353-2466
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG499902080P0205X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0205XAllopathic & Osteopathic PhysiciansPediatricsPediatric Endocrinology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G499900Medicaid
CA00G499900Medicare ID - Type Unspecified
CA00G499900Medicaid