Healthcare Provider Details

I. General information

NPI: 1093927899
Provider Name (Legal Business Name): MARTIN S. WASSERMAN M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2007
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 E CHANNEL RD.
SANTA MONICA. CA
90402
US

IV. Provider business mailing address

510 E CHANNEL RD.
SANTA MONICA. CA
90402
US

V. Phone/Fax

Practice location:
  • Phone: 310-454-8870
  • Fax:
Mailing address:
  • Phone: 310-454-8870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARTIN S. WASSERMAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 310-454-8870