Provider Demographics
NPI:1962563338
Name:LIBANATI, CESAR (MD)
Entity type:Individual
Prefix:
First Name:CESAR
Middle Name:
Last Name:LIBANATI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 FOOTHILL RD
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-2147
Mailing Address - Country:US
Mailing Address - Phone:805-676-1589
Mailing Address - Fax:909-478-0618
Practice Address - Street 1:10459 MOUNTAIN VIEW AVE
Practice Address - Street 2:SUITE F
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-2033
Practice Address - Country:US
Practice Address - Phone:909-796-8470
Practice Address - Fax:909-478-0618
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0454410207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2182935Medicaid
CA00A454410OtherMEDICAL
CAA0454410OtherSTATE MEDICAL LICENSE
00A454410Medicare ID - Type Unspecified
CAA0454410OtherSTATE MEDICAL LICENSE