Provider Demographics
NPI:1871758367
Name:MAURICE S. HABER, M.D. A MEDICAL CORPORATION
Entity type:Organization
Organization Name:MAURICE S. HABER, M.D. A MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:
Authorized Official - First Name:MAURICE
Authorized Official - Middle Name:S
Authorized Official - Last Name:HABER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-766-5231
Mailing Address - Street 1:12626 RIVERSIDE DR STE 506
Mailing Address - Street 2:
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607-3461
Mailing Address - Country:US
Mailing Address - Phone:818-766-5231
Mailing Address - Fax:818-766-9083
Practice Address - Street 1:12626 RIVERSIDE DR
Practice Address - Street 2:#506
Practice Address - City:VALLEY VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91607-3420
Practice Address - Country:US
Practice Address - Phone:818-766-5231
Practice Address - Fax:818-766-9083
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MAURICE S. HABER, M.D.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-07-23
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA28340261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A283400Medicaid
CAA28340Medicare PIN
CA00A283400Medicaid