Provider Demographics
NPI:1306897053
Name:NESHKES, ROBERT ELLIOT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:ELLIOT
Last Name:NESHKES
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:PO BOX 84353
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90073-0353
Mailing Address - Country:US
Mailing Address - Phone:424-832-8369
Mailing Address - Fax:424-832-8270
Practice Address - Street 1:11500 NIMITZ AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-3566
Practice Address - Country:US
Practice Address - Phone:424-832-8369
Practice Address - Fax:424-832-8270
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-15
Last Update Date:2015-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC399292084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAC39929Medicare Oscar/Certification