Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 213E00000X | Podiatrist | E4249 | CA |
N | 222Z00000X | Podiatrist | E4249 | CA |
N | 2081S0010X | Sports Medicine | E4249 | CA |
N | 213ES0000X | Sports Medicine | E4249 | CA |
Y | 213ES0103X | Foot & Ankle Surgery | E4249 | CA |
N | 213ES0131X | Foot Surgery | E4249 | CA |
NPI | 1376683052 |
---|---|
Provider Name | Jonathan Labovitz |
First Address | Pomona, CA 91766-2007 |
Second Address | Pomona, CA 91766-2007 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/02/2007 |
Last Update Date | 19/04/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DJ484Y | MEDICARE NO CA PTAN (01) | CA |
DJ484Z | MEDICARE SO CA PTAN (01) | CA |
E4249 | CA DPM LICENSE (01) | CA |
U83167 | (02) | CA |