Provider Demographics
NPI:1841332053
Name:HABBESTAD, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:HABBESTAD
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 1:9655 MONTE VISTA AVE STE 403
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2238
Mailing Address - Country:US
Mailing Address - Phone:909-621-7321
Mailing Address - Fax:909-621-1491
Practice Address - Street 1:9655 MONTE VISTA AVE STE 403
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2238
Practice Address - Country:US
Practice Address - Phone:909-621-7321
Practice Address - Fax:909-621-1491
Is Sole Proprietor?:No
Enumeration Date:2007-02-13
Last Update Date:2019-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35077207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A350772Medicaid
CA00A350773Medicaid
CA00A350772Medicaid
CAA84731Medicare UPIN
CA00A350773Medicaid