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General NPI Number Information
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NPI Number | 1205126224
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Entity Type | Organization
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Legal Business Name | HOOSHANG TABIBIAN MEDICAL CORPORATION, INC.
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Dates
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Enumeration Date | 04/11/2011
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Last Update Date | 02/20/2012
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Provider Practice Location Address
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Address Line | 11611 SAN VICENTE BLVD GROUND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90049-5106
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Country | US
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Telephone | 310-447-6060
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Fax |
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Provider Business Mailing Address
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Address Line | 11611 SAN VICENTE BLVD GROUND FLOOR
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City | LOS ANGELES
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State | CA
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Zip | 90049-5106
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | HOOSHANG TABIBIAN
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Credential | M.D.
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Telephone | 310-447-6060
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 173000000X
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Taxonomy Name | Legal Medicine
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License Number | A40845
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License Number State | CA
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