Provider Demographics
NPI:1114105079
Name:ALLA LIBERSTEIN, MD, INC.
Entity Type:Organization
Organization Name:ALLA LIBERSTEIN, MD, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALLA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIBERSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-793-2587
Mailing Address - Street 1:277 W PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:PORTERVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:93257-3450
Mailing Address - Country:US
Mailing Address - Phone:559-793-2587
Mailing Address - Fax:559-793-2525
Practice Address - Street 1:277 W PUTNAM AVE
Practice Address - Street 2:
Practice Address - City:PORTERVILLE
Practice Address - State:CA
Practice Address - Zip Code:93257-3450
Practice Address - Country:US
Practice Address - Phone:559-793-2587
Practice Address - Fax:559-793-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-03
Last Update Date:2012-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1083409OtherCLIA NUMBER
CA05D1083409OtherCLIA NUMBER