Basic Information
| Provider Information | |||||||||
| NPI: | 1366470338 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TABIBIAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | P. | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TABIBIAN | ||||||||
| OtherFirstName: | PARHAM | ||||||||
| OtherMiddleName: | M. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 2733 AQUA VERDE CIR | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900771502 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3107386006 | ||||||||
| FaxNumber: | 8187068822 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 KATELLA AVE | ||||||||
| Address2: | STE 430 | ||||||||
| City: | LOS ALAMITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907203338 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5627993330 | ||||||||
| FaxNumber: | 5627993399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/29/2006 | ||||||||
| LastUpdateDate: | 10/13/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | G80532 | CA | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.