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General NPI Number Information
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NPI Number | 1790995645
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Entity Type | Organization
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Legal Business Name | MARTIN S. COUSINEAU M.D. INC.
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 450 N ROXBURY DR STE 250
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City | BEVERLY HILLS
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State | CA
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Zip | 90210-4240
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Country | US
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Telephone | 310-246-4628
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Fax |
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Provider Business Mailing Address
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Address Line | 9903 SANTA MONICA BLVD # 752
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City | BEVERLY HILLS
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State | CA
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Zip | 90212-1606
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Country | US
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Telephone | 310-557-0049
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARTIN SHIELDS COUSINEAU
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Credential |
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Telephone | 310-557-0049
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | G50372
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License Number State | CA
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