Provider Demographics
NPI:1528093085
Name:BARSTIS, JOHN L (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:BARSTIS
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 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5632
Mailing Address - Country:US
Mailing Address - Phone:661-255-5350
Mailing Address - Fax:661-255-9907
Practice Address - Street 1:23929 MCBEAN PKWY
Practice Address - Street 2:BLDG F STE 215
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4466
Practice Address - Country:US
Practice Address - Phone:661-255-5350
Practice Address - Fax:661-255-9907
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2010-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39366207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G393660Medicaid
CA00G393660Medicaid
CAWG39366CMedicare PIN
CAWG39366GMedicare PIN