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Individual

BURTON A LIEBROSS

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
5525 ETIWANDA AVE, SUITE 320, TARZANA, CA 91356-3647
(818) 774-3838
(818) 774-3590
Mailing address
5805 SEPULVEDA BLVD, SUITE 610, VAN NUYS, CA 91411-2546
(818) 908-8048
(818) 908-8072

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
G32169
CA
207RN0300X
Nephrology Physician
Primary
G32169
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
95-3629679
TAX ID
CA
Enumeration date
01/16/2006
Last updated
10/24/2016
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