Provider Demographics
NPI:1356341671
Name:LETAMENDI, ROBERT FRANCISCO (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:FRANCISCO
Last Name:LETAMENDI
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 1:21 BRENNAN ST
Mailing Address - Street 2:SUITE 21
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-4337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 BRENNAN ST
Practice Address - Street 2:SUITE 21
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-4337
Practice Address - Country:US
Practice Address - Phone:831-728-4030
Practice Address - Fax:831-728-3205
Is Sole Proprietor?:No
Enumeration Date:2005-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA50002207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A500020Medicaid
CA00A500020Medicare ID - Type Unspecified
CAF-48642Medicare UPIN