Provider Demographics
NPI:1851597413
Name:SIBLEY, ROBERT DAVID JR (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:DAVID
Last Name:SIBLEY
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10780 SANTA MONICA BLVD
Mailing Address - Street 2:SUITE 490
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-4749
Mailing Address - Country:US
Mailing Address - Phone:310-470-4343
Mailing Address - Fax:310-470-4466
Practice Address - Street 1:10780 SANTA MONICA BLVD
Practice Address - Street 2:SUITE 490
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:310-470-4343
Practice Address - Fax:310-470-4466
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2014-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG186612081P0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P0004XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSpinal Cord Injury Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW16613AMedicare ID - Type UnspecifiedMEDICARE GROUP
CAA40389Medicare UPIN
CAWG18661EMedicare ID - Type UnspecifiedINDIVIDUAL