Provider Demographics
NPI:1891283362
Name:LIBBY, JOANNA MARGARET (MD)
Entity type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:MARGARET
Last Name:LIBBY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:8700 BEVERLY BLVD
Mailing Address - Street 2:SUITE 5512
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:360 SAN MIGUEL DR STE 300
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7820
Practice Address - Country:US
Practice Address - Phone:949-557-0830
Practice Address - Fax:949-557-0831
Is Sole Proprietor?:No
Enumeration Date:2018-04-30
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA165434207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program