MEDICARE: DR. JEFFREY L SEBASTIAN M.D.

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	208600000X	Surgery Physician	A60390	CA
2	2086S0122X	Plastic and Reconstructive Surgery Physician	A60390	CA

General Provider Information

NPI Number	:	1992891881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JEFFREY L SEBASTIAN M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/05/2006
Last Update Date	:	02/20/2014

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