Provider Demographics
NPI:1013921634
Name:LIBERMAN, MIRYAM (MD)
Entity Type:Individual
Prefix:DR
First Name:MIRYAM
Middle Name:
Last Name:LIBERMAN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31822 VILLAGE CENTER RD
Mailing Address - Street 2:SUITE 107
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-4316
Mailing Address - Country:US
Mailing Address - Phone:818-991-7315
Mailing Address - Fax:818-991-0575
Practice Address - Street 1:31822 VILLAGE CENTER RD
Practice Address - Street 2:SUITE 107
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4316
Practice Address - Country:US
Practice Address - Phone:818-991-7315
Practice Address - Fax:818-991-0575
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46897207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine