MEDICARE: JEFFREY L. SEBASTIAN, M D, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2086S0122X	Plastic and Reconstructive Surgery Physician	A060390	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	W18298A	OTHER	CA	MEDICARE GROUP ID

General Provider Information

NPI Number	:	1093994212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFREY L. SEBASTIAN, M D, INC

Provider Business Mailing Address
First Line	:	1260 15TH ST STE 709
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1142
Country	:	US
Telephone Number	:	310-917-4433
Fax Number	:	310-917-4432

Provider Business Practice Location Address
First Line	:	1260 15TH ST STE 709
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90404-1142
Country	:	US
Telephone Number	:	310-917-4433
Fax Number	:	310-917-4432

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JEFFREY L SEBASTIAN
Credential	:	M.D.
Telephone Number	:	310-917-4433

Provider Enumeration Date	:	10/25/2007
Last Update Date	:	08/31/2023

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