Provider Demographics
NPI:1881742203
Name:FAGUET, ROBERT ANDREW (MD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:ANDREW
Last Name:FAGUET
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:3201 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 304
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-2344
Mailing Address - Country:US
Mailing Address - Phone:310-477-9833
Mailing Address - Fax:310-264-5931
Practice Address - Street 1:3201 WILSHIRE BLVD
Practice Address - Street 2:SUITE 304
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-2344
Practice Address - Country:US
Practice Address - Phone:310-477-9833
Practice Address - Fax:310-264-5931
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG20685173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine