Provider Demographics
NPI:1255385886
Name:ASHLEY, ROBERT (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ASHLEY
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 1:1100 GLENDON AVE PH 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3526
Mailing Address - Country:US
Mailing Address - Phone:310-826-1333
Mailing Address - Fax:310-826-3786
Practice Address - Street 1:1100 GLENDON AVE PH 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-3526
Practice Address - Country:US
Practice Address - Phone:310-826-1333
Practice Address - Fax:310-826-3786
Is Sole Proprietor?:No
Enumeration Date:2006-05-19
Last Update Date:2024-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA772252084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A772250OtherMEDI CAL
CAWA77225BMedicare ID - Type Unspecified
CAH77577Medicare UPIN