Healthcare Provider Details

I. General information

NPI: 1285061135
Provider Name (Legal Business Name): RAMONA TABIB, M.D. INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/07/2013
Last Update Date: 10/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16661 VENTURA BLVD SUITE 211
ENCINO CA
91436-1914
US

IV. Provider business mailing address

16661 VENTURA BLVD SUITE 211
ENCINO CA
91436-1914
US

V. Phone/Fax

Practice location:
  • Phone: 818-317-5017
  • Fax:
Mailing address:
  • Phone: 818-317-5017
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code202C00000X
TaxonomyIndependent Medical Examiner Physician
License NumberA104733
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberA104733
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License NumberA104733
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA104733
License Number StateCA
# 5
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA104733
License Number StateCA

VIII. Authorized Official

Name: RAMONA TABIB
Title or Position: PRESIDENT
Credential:
Phone: 818-317-5017