Healthcare Provider Details

I. General information

NPI: 1962401687
Provider Name (Legal Business Name): DAVID BRET BARON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 11/26/2012
Certification Date:
Deactivation Date: 03/17/2006
Reactivation Date: 03/31/2006

III. Provider practice location address

22601 PACIFIC COAST HWY SUITE 240
MALIBU CA
90265-5856
US

IV. Provider business mailing address

22601 PACIFIC COAST HWY SUITE 240
MALIBU CA
90265-5856
US

V. Phone/Fax

Practice location:
  • Phone: 310-456-6505
  • Fax: 310-456-8105
Mailing address:
  • Phone: 310-456-6505
  • Fax: 310-456-8105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG67527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: