Healthcare Provider Details

I. General information

NPI: 1912190752
Provider Name (Legal Business Name): JOHN M. ANASTASATOS M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2007
Last Update Date: 08/05/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

436 N BEDFORD DR SUITE 200
BEVERLY HILLS CA
90210-4310
US

IV. Provider business mailing address

436 N BEDFORD DR SUITE 200
BEVERLY HILLS CA
90210-4310
US

V. Phone/Fax

Practice location:
  • Phone: 310-888-4048
  • Fax: 310-888-2827
Mailing address:
  • Phone: 310-888-4048
  • Fax: 310-888-2827

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License NumberA92907
License Number StateCA

VIII. Authorized Official

Name: DR. JOHN M. ANASTASATOS
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-888-4048