=====================================================
General NPI Number Information
=====================================================
NPI Number | 1376785154
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | BITA V NAINI M.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/25/2009
-----------------------------------------------------
Last Update Date | 10/15/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | UCLA PATH AND LAB MEDICINE A7-149 CHS, MAIL CODE: 173216
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90095-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-825-5719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | UCLA PATH AND LAB MEDICINE A7-149 CHS, MAIL CODE: 173216
-----------------------------------------------------
City | LOS ANGELES
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90095-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 310-825-5719
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207ZP0102X
-----------------------------------------------------
Taxonomy Name | Anatomic Pathology & Clinical Pathology Physician
-----------------------------------------------------
License Number | A98015
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------