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General NPI Number Information
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NPI Number | 1124083274
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Entity Type | Organization
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Legal Business Name | ANTAKI & ASSOCIATES INFECTIOUS DISEASE MEDICAL GROUP INC
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Dates
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Enumeration Date | 04/20/2006
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Last Update Date | 02/05/2018
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Provider Practice Location Address
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Address Line | 801 S CHEVY CHASE DR 101
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City | GLENDALE
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State | CA
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Zip | 91205-4431
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Country | US
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Telephone | 818-242-5299
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Fax | 818-637-7607
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Provider Business Mailing Address
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Address Line | 801 S CHEVY CHASE DR 101
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City | GLENDALE
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State | CA
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Zip | 91205-4431
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Country | US
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Telephone | 818-242-5299
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Fax | 818-637-7607
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Authorized Official
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Title or Position | OWNER
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Name | DR. JEAN-PEIRRE ANTAKI
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Credential | M.D.
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Telephone | 818-242-5299
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RI0200X
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Taxonomy Name | Infectious Disease Physician
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License Number |
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License Number State | CA
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