1366617177 NPI number — JACOB E TAUBER MD A PROFESSIONAL

Table of content: (NPI 1366617177)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366617177 NPI number — JACOB E TAUBER MD A PROFESSIONAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACOB E TAUBER MD A PROFESSIONAL
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:
1366617177
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/20/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9033 WILSHIRE BLVD
Provider Second Line Business Mailing Address:
SUITE 401
Provider Business Mailing Address City Name:
BEVERLY HILLS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90211-1837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
310-273-1003
Provider Business Mailing Address Fax Number:
310-273-2551

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1505 WILSON TER
Provider Second Line Business Practice Location Address:
SUITE 310
Provider Business Practice Location Address City Name:
GLENDALE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91206-4071
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
818-502-1130
Provider Business Practice Location Address Fax Number:
818-502-9031
Provider Enumeration Date:
04/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
TAUBER
Authorized Official First Name:
JACOB
Authorized Official Middle Name:
E
Authorized Official Title or Position:
PHYSICIAN SURGEON
Authorized Official Telephone Number:
310-273-1003

Provider Taxonomy Codes

  • Taxonomy code: 207X00000X , with the licence number:  G41526 , 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)





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