Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | G38159 | CA |
NPI | 1043244536 |
---|---|
Provider Name | Robert Daniel Leibowitz |
First Address | Los Angeles, CA 90048-5901 |
Second Address | Los Angeles, CA 90048-5901 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 19/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G381590 | MEDICAL PPIN # (01) | CA |
A91969 | (02) | CA |