Provider Demographics
NPI:1992891329
Name:ASZTERBAUM, MICHELLE (MD)
Entity type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:
Last Name:ASZTERBAUM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE STE 807
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7709
Mailing Address - Country:US
Mailing Address - Phone:949-525-0700
Mailing Address - Fax:866-299-5012
Practice Address - Street 1:1441 AVOCADO AVE STE 807
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7709
Practice Address - Country:US
Practice Address - Phone:949-525-0700
Practice Address - Fax:866-299-5012
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG81356207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G1813560OtherBLUE SHIELD OF CALIFORNIA
CAWG81356BMedicare ID - Type Unspecified
CAWG81356AMedicare ID - Type Unspecified
CA00G1813560OtherBLUE SHIELD OF CALIFORNIA