Healthcare Provider Details

I. General information

NPI: 1922149863
Provider Name (Legal Business Name): SOUZAN SANATI MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8700 BEVERLY BLVD # SB290
WEST HOLLYWOOD CA
90048-1804
US

IV. Provider business mailing address

660 S EUCLID AVE C B 8118
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone: 310-248-6240
  • Fax: 310-439-1906
Mailing address:
  • Phone: 314-362-5641
  • Fax: 314-362-0369

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207ZC0500X
TaxonomyCytopathology Physician
License Number2007001641
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License Number2007001641
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207ZP0102X
TaxonomyAnatomic Pathology & Clinical Pathology Physician
License NumberC137975
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: