Robert D Henretig, M.D.

Primary specialty

Diagnostic Radiology PhysicianTaxonomy code 2085R0202X

License

G16850 Issued in CA

Practice address

2180 Johnson Ave
Ste a
San Luis Obispo, CA 93401-4513

Phone

(805) 269-1313

Fax

(805) 269-1387

NPI assigned

Jul 21, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Community Health Centers of the Central Coast Inc

  • Federally Qualified Health Center (FQHC)
  • Cambria, CA
  • NPI 1881611705
  NPD (past)
• Desert Advanced Imaging Medical Center

  • Diagnostic Radiology Physician
  • Palm Desert, CA
  • NPI 1568416147
  NPD (past)
• Fresno Imaging Center

  • Diagnostic Radiology Physician
  • Fresno, CA
  • NPI 1659456499
  NPD (past)
• Valley Imaging

  • Radiology Clinic/Center
  • Yakima, WA
  • NPI 1093750614
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1388707200000",
    "number": "1366463879",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "150 TEJAS PL",
            "city": "NIPOMO",
            "state": "CA",
            "postal_code": "934449123",
            "telephone_number": "805-929-3211",
            "fax_number": "805-929-6359"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2180 JOHNSON AVE",
            "address_2": "STE A",
            "city": "SAN LUIS OBISPO",
            "state": "CA",
            "postal_code": "934014513",
            "telephone_number": "805-269-1313",
            "fax_number": "805-269-1387"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRETIG",
        "first_name": "ROBERT",
        "middle_name": "D",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-21",
        "last_updated": "2014-01-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "CA",
            "license": "G16850",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "8131633",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "KFHC71031F",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Carolyn R. Henderson, MFT
• Darla Henderson
• Laura Henderson
• Malia Pearl Henderson, AUD
• Benjamin Kevin Hendricks, MD
• Henry Lee, MD Inc
• Marjorie June Henry, LMFT
• Cayla Hensley
• Krisitna Rose Henson, SERVICE COORDINATOR
• Peggy Henson

• Diagnostic Radiology Physician in San Luis Obispo, CA
• Providers in San Luis Obispo, CA by specialty
• Diagnostic Radiology Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.