Provider Demographics
NPI:1659385664
Name:LUBENS, PERRY ROBERT (MD)
Entity Type:Individual
Prefix:
First Name:PERRY
Middle Name:ROBERT
Last Name:LUBENS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 91567
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90809-1567
Mailing Address - Country:US
Mailing Address - Phone:562-225-0178
Mailing Address - Fax:562-988-5901
Practice Address - Street 1:2880 ATLANTIC AVE
Practice Address - Street 2:SUITE # 260
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1716
Practice Address - Country:US
Practice Address - Phone:562-426-3319
Practice Address - Fax:562-490-3584
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-10-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG329892084N0402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084N0402XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurology with Special Qualifications in Child Neurology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA45376Medicare UPIN