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General NPI Number Information
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NPI Number | 1043232960
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Entity Type | Individual
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Provider Name | LARRY EISENBERG MD
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Gender | Male
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Dates
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Enumeration Date | 07/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 18372 CLARK ST #216
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-705-8559
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Fax | 818-705-6475
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Provider Business Mailing Address
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Address Line | 18372 CLARK ST #216
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City | TARZANA
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State | CA
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Zip | 91356
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Country | US
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Telephone | 818-705-8559
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Fax | 818-705-6475
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2080P0206X
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Taxonomy Name | Pediatric Gastroenterology Physician
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License Number | G47433
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License Number State | CA
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