Healthcare Provider Details

I. General information

NPI: 1285644963
Provider Name (Legal Business Name): ROBERT L LEIBOWITZ MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 05/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2080 CENTURY PARK E SUITE 1005
LOS ANGELES CA
90067-2013
US

IV. Provider business mailing address

2080 CENTURY PARK E SUITE 1005
LOS ANGELES CA
90067-2013
US

V. Phone/Fax

Practice location:
  • Phone: 310-229-3555
  • Fax: 310-229-3554
Mailing address:
  • Phone: 310-229-3555
  • Fax: 310-229-3554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberG28905
License Number StateCA

VIII. Authorized Official

Name: DR. ROBERT L LEIBOWITZ
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-229-3555