MEDICARE: DR. ADITI DASTANE 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	291U00000X	Clinical Medical Laboratory	TRL2540	CA

General Provider Information

NPI Number	:	1114151644
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADITI DASTANE MD

Provider Business Mailing Address
First Line	:	1328 BARRY AVE
Second Line	:	APT. # 7
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-3977
Country	:	US
Telephone Number	:	310-794-1048
Fax Number	:

Provider Business Practice Location Address
First Line	:	1000 VETERAN AVE
Second Line	:	ROOM 2-226
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2704
Country	:	US
Telephone Number	:	310-825-9352
Fax Number	:

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

Provider Enumeration Date	:	05/12/2009
Last Update Date	:	05/12/2009

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