| Stanton G. Axline M.d. A Medical Corporation | |
|
2001 Santa Monica Blvd Suite 655w Santa Monica CA 90404-2102 | |
| (310) 829-0919 | |
| (310) 829-1260 |
| Full Name | Stanton G. Axline M.d. A Medical Corporation |
|---|---|
| Speciality | Internal Medicine |
| Location | 2001 Santa Monica Blvd, Santa Monica, California |
| Authorized Official Name and Position | Stanton G Axline (OWNER) |
| Authorized Official Contact | 3108290912 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Stanton G. Axline M.d. A Medical Corporation 2001 Santa Monica Blvd Suite 655w Santa Monica CA 90404-2102 Ph: (310) 829-0919 | Stanton G. Axline M.d. A Medical Corporation 2001 Santa Monica Blvd Suite 655w Santa Monica CA 90404-2102 Ph: (310) 829-0919 |
| NPI Number | 1437422292 |
|---|---|
| Provider Enumeration Date | 02/09/2012 |
| Last Update Date | 02/13/2020 |
| Medicare PECOS PAC ID | 5698932044 |
|---|---|
| Medicare Enrollment ID | O20120213000849 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1437422292 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RI0200X | Internal Medicine - Infectious Disease | C23954 (California) | Primary |
| Provider Name | Stanton G Axline |
|---|---|
| Provider Type | Practitioner - Infectious Disease |
| Provider Identifiers | NPI Number: 1437215803 PECOS PAC ID: 6204997778 Enrollment ID: I20081203000456 |
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