MEDICARE: MRS. MOLLIE RITTER P.A.-C

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	363A00000X	Physician Assistant	10082	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA19980	OTHER	CA	STATE LICENSE

General Provider Information

NPI Number	:	1336170125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MOLLIE RITTER P.A.-C

Provider Business Mailing Address
First Line	:	8501 WILSHIRE BLVD
Second Line	:	SUITE 150
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3150
Country	:	US
Telephone Number	:	612-236-5534
Fax Number	:

Provider Business Practice Location Address
First Line	:	8501 WILSHIRE BLVD
Second Line	:	SUITE 150
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3150
Country	:	US
Telephone Number	:	612-236-5534
Fax Number	:

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

Provider Enumeration Date	:	07/06/2006
Last Update Date	:	02/09/2009

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