Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207N00000X | Dermatologist | G47175 | CA |
Y | 207NS0135X | Procedural Dermatology | G47175 | CA |
N | 207YS0123X | Facial Plastic Surgeon | G47175 | CA |
N | 207YX0007X | Plastic Surgeon (Head & Neck) | G47175 | CA |
NPI | 1427101443 |
---|---|
Provider Name | Dr. George Anterasian |
First Address | Calabasas, CA 91302-3627 |
Second Address | Santa Monica, CA 90404-2095 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2007 |
Last Update Date | 28/04/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
A92706 | (02) |