Basic Information
| Provider Information | |||||||||
| NPI: | 1922006188 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | IZENBERG | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | NAVAL MEDICAL CENTER DEPT OF SURGERY | ||||||||
| Address2: | 34730 BOB WILSON DR., BLDG 3, 4TH FLOOR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921343400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195327006 | ||||||||
| FaxNumber: | 6195327673 | ||||||||
| Practice Location | |||||||||
| Address1: | NAVAL MEDICAL CENTER DEPT OF SURGERY | ||||||||
| Address2: | 34730 BOB WILSON DR., BLDG 3, 4TH FLOOR | ||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921343400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6195327006 | ||||||||
| FaxNumber: | 6195327673 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2005 | ||||||||
| LastUpdateDate: | 01/23/2012 | ||||||||
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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 | 208600000X | G 58288 | CA | N | Allopathic & Osteopathic Physicians | Surgery | 208600000X | M 9378 | ID | N | Allopathic & Osteopathic Physicians | Surgery | 2086S0102X | G58288 | CA | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | M9378 | ID | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0127X | G58288 | CA | Y | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery | 2086S0127X | M9378 | ID | N | Allopathic & Osteopathic Physicians | Surgery | Trauma Surgery |
No ID Information.