Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NX0100X | Occupational Health | DC25431 | CA |
NPI | 1043635865 |
---|---|
Provider Name | Dr. Alan Ebling |
First Address | Marina Del Rey, CA 90292-5152 |
Second Address | Venice, CA 90291-4801 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/03/2014 |
Last Update Date | 03/03/2014 |