Provider Demographics
NPI:1295938033
Name:LUBOW, HENRY WAYNE
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:WAYNE
Last Name:LUBOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23480 PARK SORRENTO
Mailing Address - Street 2:SUITE 100-B
Mailing Address - City:CALABASAS
Mailing Address - State:CA
Mailing Address - Zip Code:91302-1352
Mailing Address - Country:US
Mailing Address - Phone:818-222-9304
Mailing Address - Fax:818-222-9310
Practice Address - Street 1:23480 PARK SORRENTO
Practice Address - Street 2:SUITE 100-B
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-1352
Practice Address - Country:US
Practice Address - Phone:818-222-9304
Practice Address - Fax:818-222-9310
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27659174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG27659OtherSTATE LICENSE
CAG27659OtherSTATE LICENSE