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General NPI Number Information
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NPI Number | 1952752644
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Entity Type | Individual
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Provider Name | ALVIN M GOTTLIEB MD
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Gender | Male
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Dates
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Enumeration Date | 06/24/2016
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Last Update Date | 06/24/2016
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Provider Practice Location Address
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Address Line | 30738 VIA LA CRESTA
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City | RANCHO PALOS VERDES
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State | CA
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Zip | 90275
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Country | US
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Telephone | 310-541-8994
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2743
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City | PALOS VERDES PENINSULA
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State | CA
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Zip | 90274-8743
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Country | US
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Telephone | 310-541-8994
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A28652
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License Number State | CA
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