Healthcare Provider Details

I. General information

NPI: 1427101443
Provider Name (Legal Business Name): GEORGE ANTERASIAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2007
Last Update Date: 04/28/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2336 SANTA MONICA BLVD SUITE 209
SANTA MONICA CA
90404-2095
US

IV. Provider business mailing address

4122 PRADO DE LAS CABRAS
CALABASAS CA
91302-3627
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-9289
  • Fax: 310-829-3809
Mailing address:
  • Phone: 818-667-2720
  • Fax: 310-829-3809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberG47175
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberG47175
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207YS0123X
TaxonomyFacial Plastic Surgery Physician
License NumberG47175
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code207YX0007X
TaxonomyPlastic Surgery within the Head & Neck (Otolaryngology) Physician
License NumberG47175
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: