Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | A107422 | CA |
N | 207XS0114X | Adult Reconstructive Orthopaedic Surgeon | 250199 | MA |
NPI | 1295929826 |
---|---|
Provider Name | Dr. John Vincent Tiberi III |
First Address | Los Angeles, CA 90045-9212 |
Second Address | Los Angeles, CA 90045-9212 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/08/2007 |
Last Update Date | 01/12/2017 |