Provider Demographics
NPI:1427277185
Name:LOGAN, ROBERT JAMES
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:JAMES
Last Name:LOGAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4426 HUDDART AVE
Mailing Address - Street 2:
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91731-1424
Mailing Address - Country:US
Mailing Address - Phone:626-279-9542
Mailing Address - Fax:323-664-7342
Practice Address - Street 1:4445 BURNS AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2702
Practice Address - Country:US
Practice Address - Phone:323-664-8969
Practice Address - Fax:323-664-1786
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)