MEDICARE: MIRNA TOVAR

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	171M00000X	Case Manager/Care Coordinator

General Provider Information

NPI Number	:	1265686240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRNA TOVAR

Provider Business Mailing Address
First Line	:	3954 PRINCETON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1944
Country	:	US
Telephone Number	:	323-482-2062
Fax Number	:

Provider Business Practice Location Address
First Line	:	3954 PRINCETON ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90023-1944
Country	:	US
Telephone Number	:	323-482-2062
Fax Number	:

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

Provider Enumeration Date	:	11/04/2008
Last Update Date	:	11/04/2008

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Directions to “ MIRNA TOVAR ” Practice Location

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