Individual
JAY I. LA BOURENE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1550-G TIBURON BLVD, TIBURON, CA 94920
(415) 833-2000
Mailing address
1550 TIBURON BLVD STE G, TIBURON, CA 94920-2531
(415) 833-2000
Taxonomy
Speciality
Code
Description
License number
State
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
G79536
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G795360
—
CA
01
—
1225508385
NPI-TYPE 2
CA
Enumeration date
11/01/2006
Last updated
12/04/2018
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