Healthcare Provider Details

I. General information

NPI: 1477642502
Provider Name (Legal Business Name): MICHAEL TOISERKANI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 08/28/2020
Certification Date: 08/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

2121 SANTA MONICA BLVD PROVIDENCE SAINT JOHN'S HEALTH CENTER
SANTA MONICA CA
90404-2303
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-1324
  • Fax: 424-212-5921
Mailing address:
  • Phone: 310-453-1324
  • Fax: 424-212-5921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA76707
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberA76707
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA76707
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: