Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208D00000X | General Practice Physician | A73555 | CA |
NPI | 1023126661 |
---|---|
Provider Name | Dr. Steven A Tenenbaum |
First Address | Thousand Oaks, CA 91320-6441 |
Second Address | Thousand Oaks, CA 91320-6435 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2006 |
Last Update Date | 20/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
H28501 | (02) | CA |