MEDICARE: DR. GARY SPENCER FELTON

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	103TC0700X	Clinical Psychologist	PSY3673	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY3673	OTHER	CA	STATE LICENSE NUMBER

General Provider Information

NPI Number	:	1952518284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY SPENCER FELTON

Provider Business Mailing Address
First Line	:	10780 SANTA MONICA BLVD STE 450
Second Line	:	SUITE #450
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7635
Country	:	US
Telephone Number	:	310-281-5531
Fax Number	:	310-559-8743

Provider Business Practice Location Address
First Line	:	10780 SANTA MONICA BLVD STE 450 SUITE 450
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-7635
Country	:	US
Telephone Number	:	310-281-5531
Fax Number	:	310-559-8743

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. GARY SPENCER FELTON ” Practice Location

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