Provider Demographics
NPI:1104016856
Name:ERWINN MARTIN C SISTOZA, M.D.,INC.
Entity Type:Organization
Organization Name:ERWINN MARTIN C SISTOZA, M.D.,INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ERWINN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SISTOZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-348-9138
Mailing Address - Street 1:6355 GREEN VALLEY CIR
Mailing Address - Street 2:UNIT 115
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-7073
Mailing Address - Country:US
Mailing Address - Phone:310-348-9138
Mailing Address - Fax:
Practice Address - Street 1:1711 W TEMPLE ST
Practice Address - Street 2:SUITE 5638
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90026-5421
Practice Address - Country:US
Practice Address - Phone:310-989-6107
Practice Address - Fax:310-989-6519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA76101207RG0300X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
W21149Medicare PIN