Basic Information
Provider Information | |||||||||
NPI: | 1073777934 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | KANARD | ||||||||
FirstName: | ROBERT | ||||||||
MiddleName: | CARR | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1359 | ||||||||
Address2: |   | ||||||||
City: | SAN CLEMENTE | ||||||||
State: | CA | ||||||||
PostalCode: | 926741359 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9494923514 | ||||||||
FaxNumber: | 9493662390 | ||||||||
Practice Location | |||||||||
Address1: | 400 W PUEBLO ST | ||||||||
Address2: |   | ||||||||
City: | SANTA BARBARA | ||||||||
State: | CA | ||||||||
PostalCode: | 931054353 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 8056827111 | ||||||||
FaxNumber: | 9493662390 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/10/2008 | ||||||||
LastUpdateDate: | 09/13/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 09/13/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0120X | MED-PHYS-LIC-115562 | MT | N |   | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 036121352 | IL | N |   | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | A84875 | CA | Y |   | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery |
No ID Information.