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Contact Information

ROBERT HENNESSY
3593 ARBORETUM CIR
CORONA, CA92881-3973
 Phone: 714-943-5015
 Fax:
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Family Medicine

207Q00000X 08 Physician/Family Practice
 

Occupational Medicine

2083X0100X 84 Physician/Preventive Medicine
Indicates primary specialty

NPI Profile & details for ROBERT HENNESSY · (Male)

NPI Number 1699765412
Status Active
Credentials
Entity Individual
Enumeration date 10/24/2005
Last updated 04/07/2020 - About 6 years ago
Sole proprietor 1 Yes
Identifiers
  • CA License # A114538
  • NY Medicaid 01820891
Hospital affiliation(s) Not Available
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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