Healthcare Provider Details

I. General information

NPI: 1265675615
Provider Name (Legal Business Name): RAMONA TABIB M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2009
Last Update Date: 09/27/2022
Certification Date: 09/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8549 WILSHIRE BLVD STE 369
BEVERLY HILLS CA
90211-3104
US

IV. Provider business mailing address

8549 WILSHIRE BLVD STE 369
BEVERLY HILLS CA
90211-3104
US

V. Phone/Fax

Practice location:
  • Phone: 323-379-5017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207UN0901X
TaxonomyNuclear Cardiology Physician
License NumberA104733
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207UN0902X
TaxonomyNuclear Imaging & Therapy Physician
License NumberA104733
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207UN0903X
TaxonomyIn Vivo & In Vitro Nuclear Medicine Physician
License NumberA104733
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA104733
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA104733
License Number StateCA
# 6
Primary TaxonomyY
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA104733
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: