Robert C Wormus, AUD

Primary specialty

SpecialistTaxonomy code 174400000X

Practice address

1030 S Glendale Ave Ste 506
Glendale, CA 91205-2866

Phone

(818) 240-4283

NPI assigned

May 30, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1180483200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183939200000",
    "number": "1699976209",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2275 W 25TH ST SPC 114",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907324997",
            "telephone_number": "310-548-5394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1030 S GLENDALE AVE STE 506",
            "city": "GLENDALE",
            "state": "CA",
            "postal_code": "912052866",
            "telephone_number": "818-240-4283"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WORMUS",
        "first_name": "ROBERT",
        "middle_name": "C",
        "credential": "AUD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-05-30",
        "last_updated": "2007-07-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "AU0002030",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Glendale, CA
• Providers in Glendale, CA by specialty
• Specialist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2007; 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.