MEDICARE: PROF. NAGESH P RAO PHD

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	170100000X	Ph.D. Medical Genetics	DRM 00000050	CA

General Provider Information

NPI Number	:	1801095435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PROF. NAGESH P RAO PHD

Provider Business Mailing Address
First Line	:	1000 VETERAN AVE
Second Line	:	ROOM 22-26 REHAB BLDG, UCLA CYTOGENETICS LABORATORY
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2704
Country	:	US
Telephone Number	:	310-794-1287
Fax Number	:	310-794-5099

Provider Business Practice Location Address
First Line	:	1000 VETERAN AVE
Second Line	:	ROOM 22-26 REHAB BLDG, UCLA CYTOGENETICS LABORATORY
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-2704
Country	:	US
Telephone Number	:	310-794-1287
Fax Number	:	310-794-5099

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

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	07/13/2007

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