Provider Demographics
NPI:1306062476
Name:HIBLER, ANITA W (MD)
Entity type:Individual
Prefix:
First Name:ANITA
Middle Name:W
Last Name:HIBLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 S KINGS RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90056-1627
Mailing Address - Country:US
Mailing Address - Phone:323-299-3895
Mailing Address - Fax:323-299-2130
Practice Address - Street 1:933 CENTINELA AVE STE B
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90302-1501
Practice Address - Country:US
Practice Address - Phone:210-677-5090
Practice Address - Fax:310-677-7302
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2013-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC36494174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C364940Medicaid