Healthcare Provider Details

I. General information

NPI: 1699913657
Provider Name (Legal Business Name): PAUL B. HABERMAN MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2009
Last Update Date: 01/29/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 20TH ST SUITE 360
SANTA MONICA CA
90404-2050
US

IV. Provider business mailing address

1301 20TH ST SUITE 360
SANTA MONICA CA
90404-2050
US

V. Phone/Fax

Practice location:
  • Phone: 310-828-3465
  • Fax: 310-315-0339
Mailing address:
  • Phone: 310-828-3465
  • Fax: 310-315-0339

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KAREN M IMAMURA
Title or Position: ADMINISTRATOR
Credential:
Phone: 310-828-3465