Organization
MATTHEW LUBLIN MD INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. RITA GRIGORY (BILLER)
(310) 739-1127
Entity
Organization
Contact information
Practice address
2001 SANTA MONICA BLVD, SUITE 1170W, SANTA MONICA, CA 90404-2102
(310) 828-2212
Mailing address
2001 SANTA MONICA BLVD, SUITE 1170W, SANTA MONICA, CA 90404-2102
(310) 828-2212
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
A82116
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
CB781A
MEDICARE PTAN
CA
Enumeration date
12/17/2012
Last updated
08/27/2020
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