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General NPI Number Information
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NPI Number | 1760541163
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Entity Type | Organization
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Legal Business Name | LIBRA MEDICAL GROUP INC
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Dates
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Enumeration Date | 12/08/2006
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Last Update Date | 02/27/2025
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Provider Practice Location Address
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Address Line | 8787 SHOREHAM DR APT 1206
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-2212
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Country | US
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Telephone | 424-313-8482
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Fax |
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Provider Business Mailing Address
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Address Line | 8787 SHOREHAM DR APT 1206
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90069-2212
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Country | US
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Telephone | 424-313-8482
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. HENRY DAVIDIAN
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Credential | M.D.
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Telephone | 424-313-8482
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A50204
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License Number State | CA
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