Provider Demographics
NPI:1366552150
Name:IMPROTA, ROBERT STEPH (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPH
Last Name:IMPROTA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2460 N PONDEROSA DR #A117
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93010
Mailing Address - Country:US
Mailing Address - Phone:805-484-2855
Mailing Address - Fax:805-389-1245
Practice Address - Street 1:2460 N PONDEROSA DR #A117
Practice Address - Street 2:
Practice Address - City:CAMARILLO
Practice Address - State:CA
Practice Address - Zip Code:93010
Practice Address - Country:US
Practice Address - Phone:805-484-2855
Practice Address - Fax:805-389-1245
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2011-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG19368208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG19368OtherLICENSE
CAG19368OtherLICENSE