Healthcare Provider Details

I. General information

NPI: 1346293883
Provider Name (Legal Business Name): NENAD ANTIC MC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 08/17/2020
Certification Date: 08/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1513 S GRAND AVE STE 360
LOS ANGELES CA
90015-3465
US

IV. Provider business mailing address

18000 STUDEBAKER RD STE 800
CERRITOS CA
90703-2671
US

V. Phone/Fax

Practice location:
  • Phone: 213-246-2422
  • Fax: 213-246-2019
Mailing address:
  • Phone: 562-735-3226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number31592
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number169820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: