Provider Demographics
NPI:1841731288
Name:MARTYNOVA, ANASTASIA (MD)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:
Last Name:MARTYNOVA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ANASTASIIA
Other - Middle Name:
Other - Last Name:MARTYNOVA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-865-3900
Mailing Address - Fax:
Practice Address - Street 1:1441 EASTLAKE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-1026
Practice Address - Country:US
Practice Address - Phone:323-865-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-03-18
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA163908207RH0003X
CAA163908207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
No207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology