MEDICARE: BARACK H. OBAMA

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	251300000X	Local Education Agency (LEA)

General Provider Information

NPI Number	:	1881920924
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BARACK H. OBAMA

Provider Business Mailing Address
First Line	:	19300 RINALDI ST
Second Line	:	SUITE 8270
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1651
Country	:	US
Telephone Number	:	310-682-9512
Fax Number	:

Provider Business Practice Location Address
First Line	:	19300 RINALDI ST
Second Line	:	SUITE 8270
City	:	NORTHRIDGE
State	:	CA
Zip	:	91326-1651
Country	:	US
Telephone Number	:	310-682-9512
Fax Number	:

Authorized Official
Title or Position	:	CEO/PRESIDENT
Name	:	EDNA MILLER
Credential	:
Telephone Number	:	310-628-9512

Provider Enumeration Date	:	10/24/2009
Last Update Date	:	10/24/2009

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