Basic Information
| Provider Information | |||||||||
| NPI: | 1780999813 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONTOFF | ||||||||
| FirstName: | ROBERT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2951 BURTON CIR | ||||||||
| Address2: | |||||||||
| City: | CAMBRIA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934283903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054325343 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3518 EL CAMINO REAL | ||||||||
| Address2: | |||||||||
| City: | ATASCADERO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 934222531 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8054616080 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/12/2010 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 092100 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.