MEDICARE: DR. AZITA RAYET D.D.S

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	52459	CA

General Provider Information

NPI Number	:	1891732798
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AZITA RAYET D.D.S

Provider Business Mailing Address
First Line	:	1300 N VERMONT AVE
Second Line	:	SUITE 1002
City	:	LOS ANGELES
State	:	CA
Zip	:	90027-6005
Country	:	US
Telephone Number	:	323-953-7341
Fax Number	:	323-953-6244

Provider Business Practice Location Address
First Line	:	3242 W 8TH ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2176
Country	:	US
Telephone Number	:	213-368-9779
Fax Number	:	213-368-9793

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

Provider Enumeration Date	:	05/31/2006
Last Update Date	:	05/15/2008

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