Provider Demographics
NPI:1811917073
Name:TOBIS, JONATHAN MARVIN (MD)
Entity type:Individual
Prefix:
First Name:JONATHAN
Middle Name:MARVIN
Last Name:TOBIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 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:310-825-4098
Mailing Address - Fax:310-267-0384
Practice Address - Street 1:200 MEDICAL PLAZA
Practice Address - Street 2:#365,530,420,120
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90095
Practice Address - Country:US
Practice Address - Phone:310-825-4098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2012-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG29150207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G291500OtherMEDICAL PPIN 3
CAA43963Medicare UPIN
CAWG29150IMedicare ID - Type UnspecifiedPPIN #
CAWG29150JMedicare ID - Type UnspecifiedPPIN #