Healthcare Provider Details

I. General information

NPI: 1952386583
Provider Name (Legal Business Name): ERNEST H AGATSTEIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/07/2005
Last Update Date: 10/04/2021
Certification Date: 10/04/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11411 BROOKSHIRE AVE STE 508
DOWNEY CA
90241-5007
US

IV. Provider business mailing address

PO BOX 845996
LOS ANGELES CA
90084-5996
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-0706
  • Fax: 562-861-2133
Mailing address:
  • Phone: 858-888-7700
  • Fax: 858-221-5017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberG48418
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: