MEDICARE: MRS. ANNA SPIVAK SR.

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	174400000X	Specialist	HA3437	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1801873336
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANNA SPIVAK SR.

Provider Business Mailing Address
First Line	:	425 S FAIRFAX AVE
Second Line	:	STE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3148
Country	:	US
Telephone Number	:	323-933-0363
Fax Number	:	323-933-0363

Provider Business Practice Location Address
First Line	:	425 S FAIRFAX AVE
Second Line	:	STE 202
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3148
Country	:	US
Telephone Number	:	323-933-0363
Fax Number	:	323-933-0363

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

Provider Enumeration Date	:	12/27/2005
Last Update Date	:	07/08/2007

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Directions to “ MRS. ANNA SPIVAK SR. ” Practice Location

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