Provider Demographics
NPI:1083306773
Name:LEBREOOT A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:LEBREOOT A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOOBIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:SHEMTOV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-999-7098
Mailing Address - Street 1:9171 WILSHIRE BLVD STE 526
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5530
Mailing Address - Country:US
Mailing Address - Phone:310-999-7098
Mailing Address - Fax:713-510-1548
Practice Address - Street 1:1073 ROSS AVE STE D
Practice Address - Street 2:
Practice Address - City:EL CENTRO
Practice Address - State:CA
Practice Address - Zip Code:92243-4371
Practice Address - Country:US
Practice Address - Phone:305-310-8155
Practice Address - Fax:713-510-1548
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-22
Last Update Date:2023-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric MedicineGroup - Multi-Specialty