Provider Demographics
NPI:1487289617
Name:MALTAGLIATI, ANTHONY
Entity type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:
Last Name:MALTAGLIATI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 W CARSON ST, BOX 461
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90502
Mailing Address - Country:US
Mailing Address - Phone:424-306-8070
Mailing Address - Fax:310-533-1841
Practice Address - Street 1:HARBOR-UCLA MEDICAL CENTER
Practice Address - Street 2:1000 WEST CARSON STREET, 461
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90509
Practice Address - Country:US
Practice Address - Phone:424-306-8070
Practice Address - Fax:310-533-1841
Is Sole Proprietor?:No
Enumeration Date:2020-03-09
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CA390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
0OtherN/A