Healthcare Provider Details

I. General information

NPI: 1679096150
Provider Name (Legal Business Name): SANTOSHA AESTHETICS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2017
Last Update Date: 07/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

822 S ROBERTSON BLVD STE 100
LOS ANGELES CA
90035-1630
US

IV. Provider business mailing address

118 S CLARK DR APT 104
WEST HOLLYWOOD CA
90048-3275
US

V. Phone/Fax

Practice location:
  • Phone: 310-651-6937
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number13199
License Number StateCA

VIII. Authorized Official

Name: DR. JOSEPH ENAYATI
Title or Position: MEDICAL DIRECTOR
Credential: DO
Phone: 310-651-6937