Provider Demographics
NPI:1215016746
Name:TOBINICK, EDWARD LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LEWIS
Last Name:TOBINICK
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 1:100 UCLA MEDICAL PLZ
Mailing Address - Street 2:SUITES 205-210
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-0001
Mailing Address - Country:US
Mailing Address - Phone:310-824-6191
Mailing Address - Fax:310-824-6196
Practice Address - Street 1:100 UCLA MEDICAL PLZ
Practice Address - Street 2:SUITES 205-210
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095-0001
Practice Address - Country:US
Practice Address - Phone:310-824-6191
Practice Address - Fax:310-824-6196
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37710174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist