Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G10631 | CA |
NPI | 1033396643 |
---|---|
Provider Name | Dr. Stanely Tobias |
First Address | Los Angeles, CA 90045-6200 |
Second Address | Los Angeles, CA 90045-6200 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/01/2008 |
Last Update Date | 22/07/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G103100 | (05) | CA |
A38026 | (02) | CA |