Healthcare Provider Details

I. General information

NPI: 1093291353
Provider Name (Legal Business Name): MIRIAM ROSE WINTHROP HABER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2018
Last Update Date: 02/08/2024
Certification Date: 02/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WESTWOOD PLZ STE 37-384
LOS ANGELES CA
90024-5055
US

IV. Provider business mailing address

1959 LAS TUNAS RD
SANTA BARBARA CA
93103-1722
US

V. Phone/Fax

Practice location:
  • Phone: 310-206-6721
  • Fax:
Mailing address:
  • Phone: 805-895-5684
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License NumberA164783
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA164783
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberA164783
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: