Provider Demographics
NPI:1184859068
Name:VERTLIEB, ERWIN MARK (D P O II)
Entity Type:Individual
Prefix:MR
First Name:ERWIN
Middle Name:MARK
Last Name:VERTLIEB
Suffix:
Gender:M
Credentials:D P O II
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-3289
Mailing Address - Country:US
Mailing Address - Phone:310-260-3541
Mailing Address - Fax:310-395-7971
Practice Address - Street 1:9150 IMPERIAL HWY
Practice Address - Street 2:ROOM P-31
Practice Address - City:DOWNEY
Practice Address - State:CA
Practice Address - Zip Code:90242-2835
Practice Address - Country:US
Practice Address - Phone:562-940-3694
Practice Address - Fax:562-658-7425
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-21
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator