Provider Demographics
NPI:1073536520
Name:TABIBIAN, ALLEN
Entity Type:Individual
Prefix:
First Name:ALLEN
Middle Name:
Last Name:TABIBIAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16682
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6682
Mailing Address - Country:US
Mailing Address - Phone:818-905-1240
Mailing Address - Fax:818-905-1238
Practice Address - Street 1:16500 VENTURA BLVD
Practice Address - Street 2:SUITE # 418
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2011
Practice Address - Country:US
Practice Address - Phone:818-905-1240
Practice Address - Fax:818-905-1238
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA54761207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A547610Medicaid
CA00A547610Medicaid
CAA54761AMedicare PIN