1720173248 NPI number — DOUGLAS A. WEBBER, MD, A MEDICAL CORPORATION

Table of content: (NPI 1720173248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720173248 NPI number — DOUGLAS A. WEBBER, MD, A MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOUGLAS A. WEBBER, MD, 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:
1720173248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3171 LOS FELIZ BLVD.
Provider Second Line Business Mailing Address:
SUITE 309
Provider Business Mailing Address City Name:
LOS ANGELES
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
90039-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
323-666-6000
Provider Business Mailing Address Fax Number:
323-666-3761

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3171 LOS FELIZ BLVD.
Provider Second Line Business Practice Location Address:
SUITE 309
Provider Business Practice Location Address City Name:
LOS ANGELES
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
90039-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
323-666-6000
Provider Business Practice Location Address Fax Number:
323-666-3761
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BERRY-WEBBER
Authorized Official First Name:
JOANNE
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
323-666-6000

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  G83278 , 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: 00G832780 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: G83278 . This is a "CA STATE LICENSE #" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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