Provider Demographics
NPI:1437302692
Name:SALIB, BOULES (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:BOULES
Middle Name:
Last Name:SALIB
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19634 VENTURA BLVD
Mailing Address - Street 2:STE 321
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-2994
Mailing Address - Country:US
Mailing Address - Phone:310-388-8788
Mailing Address - Fax:855-667-6377
Practice Address - Street 1:5411 ETIWANDA AVE # 200
Practice Address - Street 2:
Practice Address - City:TARZANA
Practice Address - State:CA
Practice Address - Zip Code:91356-3648
Practice Address - Country:US
Practice Address - Phone:424-314-0270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-30
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08661500207R00000X
NY257623207R00000X
CAA125934207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB231329OtherMEDICARE PTAN