=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124295977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CENTER FOR BREAST CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/12/2008
-----------------------------------------------------
Last Update Date | 05/12/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 222 W EULALIA ST STE 315
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-2852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-243-5640
-----------------------------------------------------
Fax | 818-243-6381
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 222 W EULALIA ST STE 315
-----------------------------------------------------
City | GLENDALE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 91204-2852
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 818-243-5640
-----------------------------------------------------
Fax | 818-243-6381
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DEANNA J ATTAI
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 818-243-5640
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208600000X
-----------------------------------------------------
Taxonomy Name | Surgery Physician
-----------------------------------------------------
License Number | G8507
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------