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General NPI Number Information
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NPI Number | 1811889231
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Entity Type | Individual
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Provider Name | NIR LIEBENTHAL
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Gender | Male
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Dates
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Enumeration Date | 07/18/2025
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Last Update Date | 07/18/2025
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Provider Practice Location Address
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Address Line | 1339 20TH ST
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City | SANTA MONICA
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State | CA
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Zip | 90404-2033
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Country | US
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Telephone | 310-829-8921
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Fax |
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Provider Business Mailing Address
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Address Line | 201 N TOLUCA ST APT 16
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City | LOS ANGELES
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State | CA
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Zip | 90026-5696
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Country | US
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Telephone | 781-718-5063
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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