Provider Demographics
NPI:1285694018
Name:NAGOURNEY, ROBERT ALAN (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
Last Name:NAGOURNEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:701 E 28TH ST
Mailing Address - Street 2:STE 418
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-2759
Mailing Address - Country:US
Mailing Address - Phone:562-989-6455
Mailing Address - Fax:562-989-8160
Practice Address - Street 1:701 E 28TH ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-2759
Practice Address - Country:US
Practice Address - Phone:562-989-6455
Practice Address - Fax:562-989-8160
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG43463174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0029650Medicaid
CAW14996Medicare PIN