Active NPI
Fred Gottlieb, M.D.
- Psychiatry Physician
- Los Angeles, CA
National Provider Identifier
1891912135
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- A18704
- Practice address
- 3586 S Bentley Ave
Los Angeles, CA 90034-6505 - Phone
- (310) 839-4714
- Fax
- (310) 839-7845
- NPI assigned
- Apr 19, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | A18704 | CA | Primary |
Addresses
Primary practice location
3586 S Bentley Ave
Los Angeles, CA 90034-6505
Mailing address
3170 Antelo Rd
Los Angeles, CA 90077-1604
Phone (310) 472-5551
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| A18704 | CA | MD | Psychiatry Physician |
| 18704 | CA | MD | Mental Health Occupational Therapist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1176940800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1891912135",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3170 ANTELO RD",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900771604",
"telephone_number": "310-472-5551",
"fax_number": "310-472-9225"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3586 S BENTLEY AVE",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900346505",
"telephone_number": "310-839-4714",
"fax_number": "310-839-7845"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOTTLIEB",
"first_name": "FRED",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-04-19",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "A18704",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.