MEDICARE: MISS NATASHA KRUSE M.A.

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	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1932329042
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS NATASHA KRUSE M.A.

Provider Business Mailing Address
First Line	:	5016 W 119TH PL
Second Line	:
City	:	HAWTHORNE
State	:	CA
Zip	:	90250-2715
Country	:	US
Telephone Number	:	310-995-2628
Fax Number	:

Provider Business Practice Location Address
First Line	:	3201 WILSHIRE BLVD STE 201
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-2337
Country	:	US
Telephone Number	:	310-995-2628
Fax Number	:

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

Provider Enumeration Date	:	04/30/2007
Last Update Date	:	07/08/2007

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