MEDICARE: DR. BELLA MUSAYEVA I M.D.

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	183500000X	Pharmacist	55212	CA

General Provider Information

NPI Number	:	1184931966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BELLA MUSAYEVA I M.D.

Provider Business Mailing Address
First Line	:	1444 N VISTA ST #14
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90046
Country	:	US
Telephone Number	:	323-552-8942
Fax Number	:

Provider Business Practice Location Address
First Line	:	6726 W SUNSET BLVD
Second Line	:	RITE AID PHARMACY #6491
City	:	LOS ANGELES
State	:	CA
Zip	:	90028
Country	:	US
Telephone Number	:	323-836-0890
Fax Number	:

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

Provider Enumeration Date	:	09/01/2010
Last Update Date	:	09/01/2010

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