Provider Demographics
NPI:1982616793
Name:MILO M WEBBER M D, INC
Entity Type:Organization
Organization Name:MILO M WEBBER M D, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MILO
Authorized Official - Middle Name:MELVIN
Authorized Official - Last Name:WEBBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-338-0659
Mailing Address - Street 1:5205 S SHERBOURNE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1127
Mailing Address - Country:US
Mailing Address - Phone:310-338-0659
Mailing Address - Fax:310-338-0659
Practice Address - Street 1:3631 CRENSHAW BLVD
Practice Address - Street 2:SUITE 103
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90016-4869
Practice Address - Country:US
Practice Address - Phone:323-730-5600
Practice Address - Fax:323-730-5603
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-12
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA16893174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A16893OtherMEDICAL PROVIDER NUMBER
CAA16893Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER