Provider Demographics
NPI:1245844174
Name:RISINGER, ROBERT ALEXANDER
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALEXANDER
Last Name:RISINGER
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 1:1750 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SAN MARINO
Mailing Address - State:CA
Mailing Address - Zip Code:91108-3015
Mailing Address - Country:US
Mailing Address - Phone:626-285-3422
Mailing Address - Fax:
Practice Address - Street 1:3002 FREEBORN ST
Practice Address - Street 2:
Practice Address - City:DUARTE
Practice Address - State:CA
Practice Address - Zip Code:91010-1507
Practice Address - Country:US
Practice Address - Phone:626-993-4870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-08
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home