Basic Information
| Provider Information | |||||||||
| NPI: | 1497044341 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAUBE | ||||||||
| FirstName: | JUSTIN | ||||||||
| MiddleName: | GRAHAM | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2336 SANTA MONICA BLVD STE 301 | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042067 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109989118 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 2336 SANTA MONICA BLVD | ||||||||
| Address2: | |||||||||
| City: | SANTA MONICA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 904042095 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3109989118 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/31/2011 | ||||||||
| LastUpdateDate: | 01/31/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A124767 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.