Healthcare Provider Details

I. General information

NPI: 1043745938
Provider Name (Legal Business Name): JOSH FAGUET M.D., PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/27/2017
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 SANTA MONICA BLVD
SANTA MONICA CA
90404-2303
US

IV. Provider business mailing address

8700 BEVERLY BLVD SUITE 5512
WEST HOLLYWOOD CA
90048-1804
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-5511
  • Fax:
Mailing address:
  • Phone: 310-423-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberA157679
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: