Healthcare Provider Details

I. General information

NPI: 1740401652
Provider Name (Legal Business Name): MARC ROBERT LEBED MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

387 MIRAMAR LN
SHELL BEACH CA
93449-1542
US

IV. Provider business mailing address

387 MIRAMAR LN
SHELL BEACH CA
93449-1542
US

V. Phone/Fax

Practice location:
  • Phone: 805-773-5661
  • Fax: 805-773-8029
Mailing address:
  • Phone: 805-773-5661
  • Fax: 805-773-8029

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberG40402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: