=====================================================
General NPI Number Information
=====================================================
NPI Number | 1760725030
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MICHAEL SCHREIBER, DO
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/04/2013
-----------------------------------------------------
Last Update Date | 04/04/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2560 W OLYMPIC BLVD 201
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-383-0007
-----------------------------------------------------
Fax | 866-505-1544
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2560 W OLYMPIC BLVD 201
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90006-2972
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 213-383-0007
-----------------------------------------------------
Fax | 866-505-1544
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MICHAEL SCHREIBER
-----------------------------------------------------
Credential | DO
-----------------------------------------------------
Telephone | 310-453-8393
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207QA0505X
-----------------------------------------------------
Taxonomy Name | Adult Medicine Physician
-----------------------------------------------------
License Number | 20A5391
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------