Provider Demographics
NPI:1225072564
Name:BABARAN, JOSELITO P (MD)
Entity Type:Individual
Prefix:
First Name:JOSELITO
Middle Name:P
Last Name:BABARAN
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 1:8340 VAN NUYS BLVD UNIT L
Mailing Address - Street 2:
Mailing Address - City:PANORAMA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91402-3761
Mailing Address - Country:US
Mailing Address - Phone:818-895-4900
Mailing Address - Fax:818-895-5200
Practice Address - Street 1:9608 VAN NUYS BLVD STE 104
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-1042
Practice Address - Country:US
Practice Address - Phone:818-895-4900
Practice Address - Fax:818-895-5200
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2019-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA51480207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A514802Medicaid
CAA51480Medicaid
CA00A514800Medicare ID - Type Unspecified