MEDICARE: ANTANTA MEDICAL SPECIALISTS, 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	207R00000X	Internal Medicine Physician	A56051	CA

General Provider Information

NPI Number	:	1659453967
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ANTANTA MEDICAL SPECIALISTS, INC

Provider Business Mailing Address
First Line	:	311 N ROBERTSON BLVD # 692
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1705
Country	:	US
Telephone Number	:	323-299-7508
Fax Number	:	323-299-9376

Provider Business Practice Location Address
First Line	:	4249 1/2 CRENSHAW BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90008-2536
Country	:	US
Telephone Number	:	323-299-7508
Fax Number	:	323-299-9476

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOHN CUDE
Credential	:	DPM
Telephone Number	:	323-299-7508

Provider Enumeration Date	:	10/19/2006
Last Update Date	:	08/22/2020

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Directions to “ANTANTA MEDICAL SPECIALISTS, INC ” Practice Location

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