Healthcare Provider Details

I. General information

NPI: 1992741813
Provider Name (Legal Business Name): MATTHEW ALAN LUBLIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2006
Last Update Date: 07/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2001 SANTA MONICA BLVD STE 860W
SANTA MONICA CA
90404-2189
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD STE 1170W
SANTA MONICA CA
90404-2122
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-3209
  • Fax: 310-828-5165
Mailing address:
  • Phone: 310-417-5900
  • Fax: 310-410-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberA82116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: