Provider Demographics
NPI:1346420551
Name:HARLAN C AMSTUTZ MD INC
Entity Type:Organization
Organization Name:HARLAN C AMSTUTZ MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PHYSICIAN AND SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:HARLAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:AMSTUTZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD INC
Authorized Official - Phone:213-484-7600
Mailing Address - Street 1:2200 W 3RD ST
Mailing Address - Street 2:STE. 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-1932
Mailing Address - Country:US
Mailing Address - Phone:213-484-7600
Mailing Address - Fax:213-484-7680
Practice Address - Street 1:2200 W 3RD ST
Practice Address - Street 2:STE. 400
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-1932
Practice Address - Country:US
Practice Address - Phone:213-484-7600
Practice Address - Fax:213-484-7680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-06
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA17502207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA20926Medicare UPIN
CAW15089Medicare PIN