Healthcare Provider Details

I. General information

NPI: 1255365508
Provider Name (Legal Business Name): PETER M. BIRNSTEIN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 06/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2811 WILSHIRE BLVD STE 800
SANTA MONICA CA
90403-4808
US

IV. Provider business mailing address

2811 WILSHIRE BLVD STE 800
SANTA MONICA CA
90403-4808
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-6361
  • Fax: 310-453-6383
Mailing address:
  • Phone: 310-453-6361
  • Fax: 310-453-6383

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberG22732
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: