Individual
JONATHAN LABOVITZ
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.P.M.
Contact information
Practice address
795 E 2ND ST, SUITE 7, POMONA, CA 91766-2007
(909) 706-3877
Mailing address
795 E 2ND ST, SUITE 7, POMONA, CA 91766-2007
(909) 706-3887
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
E4249
CA
213ES0000X
Sports Medicine Podiatrist
E4249
CA
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
E4249
CA
213ES0131X
Foot Surgery Podiatrist
E4249
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DJ484Y
MEDICARE NO CA PTAN
CA
01
—
DJ484Z
MEDICARE SO CA PTAN
CA
01
—
E4249
CA DPM LICENSE
CA
Enumeration date
02/08/2007
Last updated
04/19/2013
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