Healthcare Provider Details

I. General information

NPI: 1871002618
Provider Name (Legal Business Name): PETER M BIRNSTEIN MD PROF CORP FAMILY PRACTICE ASSOC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2017
Last Update Date: 07/21/2022
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: 310-393-0245
Mailing address:
  • Phone: 310-453-6361
  • Fax: 310-393-0245

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberG22732
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207QA0505X
TaxonomyAdult Medicine Physician
License NumberG22732
License Number StateCA

VIII. Authorized Official

Name: DR. PETER M BIRNSTEIN
Title or Position: PRESIDENT
Credential: MD
Phone: 310-394-2695