Provider Demographics
NPI:1295946804
Name:HELLER, ROBERT JOEL (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:JOEL
Last Name:HELLER
Suffix:
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 1:1126 ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2835
Mailing Address - Country:US
Mailing Address - Phone:310-480-0177
Mailing Address - Fax:310-933-0243
Practice Address - Street 1:1126 ROSE AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2835
Practice Address - Country:US
Practice Address - Phone:310-480-0177
Practice Address - Fax:310-933-0243
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2009-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG8042207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA58166Medicare UPIN