Provider Demographics
NPI:1982832531
Name:ELLIOTT, ROBERT AMARU
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:AMARU
Last Name:ELLIOTT
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 1:2000 SIERRA ROAD
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94518
Mailing Address - Country:US
Mailing Address - Phone:925-363-2000
Mailing Address - Fax:925-363-2006
Practice Address - Street 1:2000 SIERRA RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94518-2208
Practice Address - Country:US
Practice Address - Phone:925-363-2000
Practice Address - Fax:925-363-2006
Is Sole Proprietor?:No
Enumeration Date:2009-06-22
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA115935208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics