Individual
ROBERT D HENRETIG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2180 JOHNSON AVE, STE A, SAN LUIS OBISPO, CA 93401-4513
(805) 269-1313
(805) 269-1387
Mailing address
150 TEJAS PL, NIPOMO, CA 93444-9123
(805) 929-3211
(805) 929-6359
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
G16850
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8131633
—
WA
05
—
KFHC71031F
—
CA
Enumeration date
07/21/2006
Last updated
01/03/2014
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