Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RN0300X | Nephrologist | A47826 | CA |
NPI | 1043323421 |
---|---|
Provider Name | Bialick Tabibian |
First Address | Los Angeles, CA 90025-0427 |
Second Address | Los Angeles, CA 90045-3819 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A478261 | (05) | CA |
B50420 | (02) | CA |