Provider Demographics
NPI:1003040478
Name:MONA TABIB MD INC
Entity Type:Organization
Organization Name:MONA TABIB MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MONA
Authorized Official - Middle Name:
Authorized Official - Last Name:TABIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-789-7893
Mailing Address - Street 1:4520 CAMINITO PL
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-4720
Mailing Address - Country:US
Mailing Address - Phone:818-789-7893
Mailing Address - Fax:818-789-2346
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 211
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-789-7893
Practice Address - Fax:818-789-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-13
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA40287207QA0505X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A402870Medicaid
CAA29091Medicare UPIN
CAA40287Medicare PIN