MEDICARE: DR. MARY DEBRA SALIBA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G082103	CA

General Provider Information

NPI Number	:	1790882124
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARY DEBRA SALIBA M.D.

Provider Business Mailing Address
First Line	:	1130 S RIDGELEY DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90019-2528
Country	:	US
Telephone Number	:	310-470-6108
Fax Number	:

Provider Business Practice Location Address
First Line	:	2320 GLENDON AVENUE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-2204
Country	:	US
Telephone Number	:	310-470-6108
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	08/20/2010

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