1639161441 NPI number — DR. LORI LIBS DC

Table of content: DR. LORI LIBS DC (NPI 1639161441)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639161441 NPI number — DR. LORI LIBS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LIBS
Provider First Name:
LORI
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TEITELBAUM
Provider Other First Name:
LORI
Provider Other Middle Name:
JILL
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
DC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1639161441
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4410 LAMONT ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN DIEGO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92109-4515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
858-483-8500
Provider Business Mailing Address Fax Number:
858-272-0054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4410 LAMONT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN DIEGO
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92109-4515
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
858-483-8500
Provider Business Practice Location Address Fax Number:
858-272-0054
Provider Enumeration Date:
08/17/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  14510 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1366565285 . This is a "MEDICARE GROUP NPI" identifier . This identifiers is of the category "OTHER".