MEDICARE: ROSSANA SIDA

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	106H00000X	Marriage & Family Therapist	LMFT116114	CA

General Provider Information

NPI Number	:	1760029128
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSSANA SIDA

Provider Business Mailing Address
First Line	:	605 S BARRINGTON AVE APT 2
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-4411
Country	:	US
Telephone Number	:	323-633-6986
Fax Number	:

Provider Business Practice Location Address
First Line	:	11835 W OLYMPIC BLVD STE 820
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90064-5033
Country	:	US
Telephone Number	:	323-633-6986
Fax Number	:

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

Provider Enumeration Date	:	12/04/2019
Last Update Date	:	12/04/2019

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Directions to “ ROSSANA SIDA ” Practice Location

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