Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207P00000X | Emergency Physician | 0101237467 | VA |
N | 207R00000X | Internist | 0101237467 | VA |
N | 111NI0900X | Internist | 0101237467 | VA |
N | 207R00000X | Internist | C55251 | CA |
N | 111NI0900X | Internist | C55251 | CA |
Y | 207RA0401X | Internist - Addiction Medicine | 61-19200 | CA |
NPI | 1063585164 |
---|---|
Provider Name | Samuel Leibovici |
First Address | Beverly Hills, CA 90211-2283 |
Second Address | Beverly Hills, CA 90211-2283 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2006 |
Last Update Date | 15/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
C55251 | INTERNAL MEDICINE (01) | CA |