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NPI Code Detail

MEDICARE: DR. JOAN C. DASTEEL MSW, PHD

MEDICARE:  DR. JOAN C. DASTEEL  MSW, PHD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerLCS2126CA

General Provider Information

NPI Number : 1043216047
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JOAN C. DASTEEL MSW, PHD
Provider Business Mailing Address
First Line : 424 N BOWLING GREEN WAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-2820
Country : US
Telephone Number : 310-471-1496
Fax Number : 310-472-5826
Provider Business Practice Location Address
First Line : 424 N BOWLING GREEN WAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90049-2820
Country : US
Telephone Number : 310-471-1496
Fax Number : 310-472-5826
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/23/2005
Last Update Date : 07/08/2007

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