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General NPI Number Information
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NPI Number | 1295000693
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Entity Type | Organization
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Legal Business Name | ALAN L. SHABO M.D. A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/19/2012
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Last Update Date | 03/19/2012
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Provider Practice Location Address
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Address Line | 10921 WILSHIRE BLVD SUITE 1205
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone | 310-824-9661
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Fax | 310-824-9867
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Provider Business Mailing Address
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Address Line | 10921 WILSHIRE BLVD SUITE 1205
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City | LOS ANGELES
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State | CA
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Zip | 90024-3906
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Country | US
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Telephone | 310-824-9661
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Fax | 310-824-9867
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Authorized Official
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Title or Position | PHYSICIAN&SURGEON/OPHTHALMOLOGIST
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Name | DR. ALAN LOUIS SHABO
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Credential | M.D.
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Telephone | 310-824-9661
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | A23893
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License Number State | CA
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