Provider Demographics
NPI:1790882124
Name:SALIBA, MARY DEBRA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:DEBRA
Last Name:SALIBA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:SALIBA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1130 S RIDGELEY DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-2528
Mailing Address - Country:US
Mailing Address - Phone:310-470-6108
Mailing Address - Fax:
Practice Address - Street 1:2320 GLENDON AVENUE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2204
Practice Address - Country:US
Practice Address - Phone:310-470-6108
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG082103207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine