Provider Demographics
NPI:1396926796
Name:JONATHAN TOBIS M.D. INC.
Entity type:Organization
Organization Name:JONATHAN TOBIS M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:MARVIN
Authorized Official - Last Name:TOBIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-476-6814
Mailing Address - Street 1:360 N SKYEWIAY RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90049-2838
Mailing Address - Country:US
Mailing Address - Phone:310-476-6814
Mailing Address - Fax:310-267-0384
Practice Address - Street 1:360 N SKYEWIAY RD
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90049-2838
Practice Address - Country:US
Practice Address - Phone:310-476-6814
Practice Address - Fax:310-267-0384
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG029150207RC0000X
CAG033021207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12266Medicare PIN