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General NPI Number Information
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NPI Number | 1679096150
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Entity Type | Organization
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Legal Business Name | SANTOSHA AESTHETICS, INC.
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Dates
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Enumeration Date | 07/17/2017
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Last Update Date | 07/17/2017
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Provider Practice Location Address
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Address Line | 822 S ROBERTSON BLVD STE 100
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City | LOS ANGELES
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State | CA
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Zip | 90035-1630
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Country | US
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Telephone | 310-651-6937
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Fax |
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Provider Business Mailing Address
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Address Line | 118 S CLARK DR APT 104
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City | WEST HOLLYWOOD
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State | CA
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Zip | 90048-3275
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. JOSEPH ENAYATI
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Credential | DO
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Telephone | 310-651-6937
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | 13199
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License Number State | CA
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