MEDICARE: NEVILLE WALLIS ANDERSON MD

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
1	208000000X	Pediatrics Physician	A91281	CA

General Provider Information

NPI Number	:	1073614574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEVILLE WALLIS ANDERSON MD

Provider Business Mailing Address
First Line	:	321 N LARCHMONT BLVD
Second Line	:	SUITE 1020
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-6410
Country	:	US
Telephone Number	:	323-960-8500
Fax Number	:	323-960-8585

Provider Business Practice Location Address
First Line	:	321 N LARCHMONT BLVD
Second Line	:	SUITE 1020
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-6410
Country	:	US
Telephone Number	:	323-960-8500
Fax Number	:	323-960-8585

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	03/07/2014

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Directions to “ NEVILLE WALLIS ANDERSON MD” Practice Location

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