Provider Demographics
NPI:1255365508
Name:BIRNSTEIN, PETER M (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:M
Last Name:BIRNSTEIN
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 1:2811 WILSHIRE BLVD STE 800
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4808
Mailing Address - Country:US
Mailing Address - Phone:310-453-6361
Mailing Address - Fax:310-453-6383
Practice Address - Street 1:2811 WILSHIRE BLVD STE 800
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4808
Practice Address - Country:US
Practice Address - Phone:310-453-6361
Practice Address - Fax:310-453-6383
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2008-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG22732174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G227320Medicaid
CAG22732Medicare ID - Type UnspecifiedLIC NUMBER
CA00G227320Medicaid