MEDICARE: ELENA RUMACK DDS

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	122300000X	Dentist	50100	CA

General Provider Information

NPI Number	:	1518080118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELENA RUMACK DDS

Provider Business Mailing Address
First Line	:	23679 CALABASAS RD
Second Line	:	SUITE # 983
City	:	CALABASAS
State	:	CA
Zip	:	91302-1502
Country	:	US
Telephone Number	:	818-222-4543
Fax Number	:	818-591-7599

Provider Business Practice Location Address
First Line	:	23695 CALABASAS RD
Second Line	:
City	:	CALABASAS
State	:	CA
Zip	:	91302-1502
Country	:	US
Telephone Number	:	818-222-4543
Fax Number	:	818-591-7599

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

Provider Enumeration Date	:	04/09/2007
Last Update Date	:	06/30/2010

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