Provider Demographics
NPI:1780787283
Name:UNGUEZ, ROBERTO T (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERTO
Middle Name:T
Last Name:UNGUEZ
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 1:2550 PACIFIC COAST HWY
Mailing Address - Street 2:#44
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-7726
Mailing Address - Country:US
Mailing Address - Phone:310-944-5632
Mailing Address - Fax:
Practice Address - Street 1:164 W CARSON ST
Practice Address - Street 2:
Practice Address - City:CARSON
Practice Address - State:CA
Practice Address - Zip Code:90745-2601
Practice Address - Country:US
Practice Address - Phone:310-518-3054
Practice Address - Fax:310-835-1366
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2017-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11040207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G110400Medicaid
CAG11040Medicare ID - Type Unspecified
CA00G110400Medicaid