Healthcare Provider Details

I. General information

NPI: 1124083274
Provider Name (Legal Business Name): ANTAKI & ASSOCIATES INFECTIOUS DISEASE MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/20/2006
Last Update Date: 02/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S CHEVY CHASE DR 101
GLENDALE CA
91205-4431
US

IV. Provider business mailing address

801 S CHEVY CHASE DR 101
GLENDALE CA
91205-4431
US

V. Phone/Fax

Practice location:
  • Phone: 818-242-5299
  • Fax: 818-637-7607
Mailing address:
  • Phone: 818-242-5299
  • Fax: 818-637-7607

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. JEAN-PEIRRE ANTAKI
Title or Position: OWNER
Credential: M.D.
Phone: 818-242-5299