Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G54512 | CA |
Y | 111NI0900X | Internist | G54512 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | G54512 | CA |
N | 207RP1001X | Pulmonary Disease | G54512 | CA |
NPI | 1740381177 |
---|---|
Provider Name | Keith S Garb |
First Address | Los Angeles, CA 90045-5631 |
Second Address | Calabasas, CA 91302-1958 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 25/02/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G545120 | BLUE SHIELD (01) | CA |
E21628 | (02) |