1053457598 NPI number — ERWIN PETER GABOR,M.D. A MEDICAL CORPORATION

Table of content: (NPI 1053457598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053457598 NPI number — ERWIN PETER GABOR,M.D. A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERWIN PETER GABOR,M.D. A MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053457598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9663 SANTA MONICA BLVD
Provider Second Line Business Mailing Address:
#792
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90210-4303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-432-8900
Provider Business Mailing Address Fax Number:
310-432-8901

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8900 WILSHIRE BLVD
Provider Second Line Business Practice Location Address:
2ND FLOOR
Provider Business Practice Location Address City Name:
BEVERLY HILLS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90211-1958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
310-432-8900
Provider Business Practice Location Address Fax Number:
310-432-8901
Provider Enumeration Date:
01/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GABOR
Authorized Official First Name:
ERWIN
Authorized Official Middle Name:
PETER
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
310-432-8900

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  A21520 , 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: 00A215200 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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