Healthcare Provider Details

I. General information

NPI: 1093169393
Provider Name (Legal Business Name): VLADIMIR ALEXANDER LJUBIMOV MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 08/12/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23560 CRENSHAW BLVD STE 101
TORRANCE CA
90505-5233
US

IV. Provider business mailing address

23560 CRENSHAW BLVD STE 101
TORRANCE CA
90505-5233
US

V. Phone/Fax

Practice location:
  • Phone: 310-517-7021
  • Fax:
Mailing address:
  • Phone: 310-517-7021
  • Fax: 310-784-1903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207T00000X
TaxonomyNeurological Surgery Physician
License NumberA162804
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: