Basic Information
| Provider Information | |||||||||
| NPI: | 1861429060 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POUSMAN | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | MARC | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 20612 PACIFIC COAST HWY | ||||||||
| Address2: | |||||||||
| City: | MALIBU | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902655403 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107746472 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6815 NOBLE AVE | ||||||||
| Address2: | STE#400 | ||||||||
| City: | VAN NUYS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 914053796 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8189016690 | ||||||||
| FaxNumber: | 8189016699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/26/2006 | ||||||||
| LastUpdateDate: | 02/28/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 20A9252 | CA | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 207LC0200X | 20A9252 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Critical Care Medicine | 207LP2900X | 20A9252 | CA | N | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00AX92520 | 05 | CA | MEDICAID | 020A92520 | 01 | CA | BLUE SHIELD OF CA | OTHER |