Organization
WARREN BANTA MD, A MEDICAL CORPORATION
Active
Organization
WARREN BANTA MD, A MEDICAL CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
WARREN BANTA MD (PRESIDENT)
(323) 229-9471
Entity
Organization
Contact information
Practice address
875 N WESTERN AVE, LOS ANGELES, CA 90029-3759
(323) 461-0777
Mailing address
875 N WESTERN AVE, LOS ANGELES, CA 90029-3759
(323) 461-0777
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
A88514
CA
Other
Enumeration date
05/19/2009
Last updated
05/19/2009
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