Provider Demographics
NPI:1679681704
Name:PRIMARY CARING OF MALIBU MEDICAL
Entity Type:Organization
Organization Name:PRIMARY CARING OF MALIBU MEDICAL
Other - Org Name:PRIMARY CARING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:BRET
Authorized Official - Last Name:BARON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-456-6505
Mailing Address - Street 1:22601 PACIFIC COAST HWY STE 240
Mailing Address - Street 2:
Mailing Address - City:MALIBU
Mailing Address - State:CA
Mailing Address - Zip Code:90265-5823
Mailing Address - Country:US
Mailing Address - Phone:310-456-6505
Mailing Address - Fax:310-456-8105
Practice Address - Street 1:22601 PACIFIC COAST HWY STE 240
Practice Address - Street 2:
Practice Address - City:MALIBU
Practice Address - State:CA
Practice Address - Zip Code:90265-5823
Practice Address - Country:US
Practice Address - Phone:310-456-6505
Practice Address - Fax:310-456-8105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-28
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG67527207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE90530Medicare UPIN
CAWG67527DMedicare ID - Type UnspecifiedDAVID B BARON MD
CAW17311Medicare ID - Type UnspecifiedGROUP ID
CAI51742Medicare UPIN