Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | G13948 | CA |
NPI | 1043360225 |
---|---|
Provider Name | Dr. Jacob Jay Lorber |
First Address | Northridge, CA 91326-3439 |
Second Address | Northridge, CA 91326-3439 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F38797 | (02) |