| Libra Medical Group Inc | |
|
1410 Miller Dr Los Angeles CA 90069-1422 | |
| (323) 650-4431 | |
| Not Available |
| Full Name | Libra Medical Group Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 1410 Miller Dr, Los Angeles, California |
| Authorized Official Name and Position | Henry Davidian (PRESIDENT) |
| Authorized Official Contact | 3236504431 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Libra Medical Group Inc 1410 Miller Dr Los Angeles CA 90069-1422 Ph: (323) 650-4431 | Libra Medical Group Inc 1410 Miller Dr Los Angeles CA 90069-1422 Ph: (323) 650-4431 |
| NPI Number | 1760541163 |
|---|---|
| Provider Enumeration Date | 12/08/2006 |
| Last Update Date | 10/03/2011 |
| Medicare PECOS PAC ID | 3072554591 |
|---|---|
| Medicare Enrollment ID | O20050516000305 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760541163 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | A50204 (California) | Primary |
| Provider Name | Henry Davidian |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1255490793 PECOS PAC ID: 8820258486 Enrollment ID: I20120320000359 |
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