Provider Demographics
NPI:1740335744
Name:AESTHETIC SURGICAL CENTER OF SANTA MONICA
Entity type:Organization
Organization Name:AESTHETIC SURGICAL CENTER OF SANTA MONICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:TEITELBAUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-315-1121
Mailing Address - Street 1:1301 20TH ST STE 350
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90404-2052
Mailing Address - Country:US
Mailing Address - Phone:310-315-1121
Mailing Address - Fax:310-315-9921
Practice Address - Street 1:1301 20TH ST STE 350
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2052
Practice Address - Country:US
Practice Address - Phone:310-315-1121
Practice Address - Fax:310-315-9921
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-23
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA105461261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1740335744Medicaid