MEDICARE: RHEUMATOLOGY ASSOCIATES

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	207RR0500X	Rheumatology Physician

General Provider Information

NPI Number	:	1225208606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RHEUMATOLOGY ASSOCIATES

Provider Business Mailing Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	SUITE 200
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3429
Country	:	US
Telephone Number	:	818-980-7010
Fax Number	:	818-980-7330

Provider Business Practice Location Address
First Line	:	12660 RIVERSIDE DR
Second Line	:	SUITE 200
City	:	NORTH HOLLYWOOD
State	:	CA
Zip	:	91607-3430
Country	:	US
Telephone Number	:	818-980-7010
Fax Number	:	818-980-7330

Authorized Official
Title or Position	:	CO PARTNER
Name	:	DR. SEAN JOSEPH WOLLASTON
Credential	:	M.D.
Telephone Number	:	818-980-7010

Provider Enumeration Date	:	03/03/2008
Last Update Date	:	06/06/2012

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