Provider Demographics
NPI:1124391412
Name:WERBACH, MELVYN (MD)
Entity Type:Individual
Prefix:DR
First Name:MELVYN
Middle Name:
Last Name:WERBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4751 VIVIANA DRIVE
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-5038
Mailing Address - Country:US
Mailing Address - Phone:818-996-4727
Mailing Address - Fax:
Practice Address - Street 1:4751 VIVIANA DR
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-5038
Practice Address - Country:US
Practice Address - Phone:818-996-4727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-16
Last Update Date:2012-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGFE15966207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine