Provider Demographics
NPI:1285644963
Name:ROBERT L LEIBOWITZ MD A PROFESSIONAL MEDICAL CORPORATION
Entity Type:Organization
Organization Name:ROBERT L LEIBOWITZ MD A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:COMPASSIONATE ONCOLOGY MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:LEIBOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-229-3555
Mailing Address - Street 1:2080 CENTURY PARK E
Mailing Address - Street 2:SUITE 1005
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2013
Mailing Address - Country:US
Mailing Address - Phone:310-229-3555
Mailing Address - Fax:310-229-3554
Practice Address - Street 1:2080 CENTURY PARK E
Practice Address - Street 2:SUITE 1005
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2013
Practice Address - Country:US
Practice Address - Phone:310-229-3555
Practice Address - Fax:310-229-3554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-08
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG28905207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA15424BOtherMEDICARE PTAN FOR NPP
CAW7145Medicare UPIN
CAWPA15424BOtherMEDICARE PTAN FOR NPP
CAA91531Medicare UPIN
CA0354120001Medicare NSC