Provider Demographics
NPI:1215972062
Name:ANATOLY POSTOLOV M.D., A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:ANATOLY POSTOLOV M.D., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANATOLY
Authorized Official - Middle Name:
Authorized Official - Last Name:POSTOLOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:818-501-4838
Mailing Address - Street 1:13749 RIVERSIDE DR
Mailing Address - Street 2:SUIT #: 200
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2415
Mailing Address - Country:US
Mailing Address - Phone:818-501-4838
Mailing Address - Fax:818-501-4348
Practice Address - Street 1:13749 RIVERSIDE DR
Practice Address - Street 2:SUIT #: 200
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2415
Practice Address - Country:US
Practice Address - Phone:818-501-4838
Practice Address - Fax:818-501-4348
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72516261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWA72615COtherPPIN
CAW18400OtherGT ID
CAH58642Medicare UPIN