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General NPI Number Information
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NPI Number | 1417222514
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Entity Type | Organization
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Legal Business Name | DEREK M DOBALIAN A MEDICAL CORPORATION
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Dates
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Enumeration Date | 03/21/2012
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Last Update Date | 03/22/2012
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Provider Practice Location Address
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Address Line | 3816 WOODRUFF AVE SUITE 307
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City | LONG BEACH
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State | CA
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Zip | 90808-2147
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Country | US
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Telephone | 562-420-7670
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Fax |
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Provider Business Mailing Address
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Address Line | 3816 WOODRUFF AVE SUITE 307
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City | LONG BEACH
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State | CA
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Zip | 90808-2147
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Country | US
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Telephone | 562-420-7670
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. DEREK MARC DOBALIAN
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Credential | M.D.
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Telephone | 562-420-7670
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | G48996
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License Number State | CA
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