Provider Demographics
NPI:1902859390
Name:ANDERSON, JOHN LITTLETON (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:LITTLETON
Last Name:ANDERSON
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 1:15910 VENTURA BLVD
Mailing Address - Street 2:SUITE 1502
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-2802
Mailing Address - Country:US
Mailing Address - Phone:818-728-9877
Mailing Address - Fax:818-728-9877
Practice Address - Street 1:15910 VENTURA BLVD
Practice Address - Street 2:SUITE 1502
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2802
Practice Address - Country:US
Practice Address - Phone:818-728-9877
Practice Address - Fax:818-728-9877
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54092207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G540920OtherBLUE SHIELD
CA00G540920Medicaid
CAE02746Medicare UPIN
CA00G540920OtherBLUE SHIELD
CADD261ZMedicare PIN