Provider Demographics
NPI:1649280074
Name:ANASTASI, JAMES LEONARD (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:LEONARD
Last Name:ANASTASI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 20TH ST
Mailing Address - Street 2:#550
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2050
Mailing Address - Country:US
Mailing Address - Phone:310-829-3544
Mailing Address - Fax:310-315-0235
Practice Address - Street 1:1301 20TH ST
Practice Address - Street 2:#550
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2050
Practice Address - Country:US
Practice Address - Phone:310-829-3544
Practice Address - Fax:310-315-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC33376173000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes173000000XOther Service ProvidersLegal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA35247Medicare UPIN