MEDICARE: JULIE ANNA TANTAU MA

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	231H00000X	Audiologist	AU2430	CA

General Provider Information

NPI Number	:	1023296373
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANNA TANTAU MA

Provider Business Mailing Address
First Line	:	468 S ROXBURY DR
Second Line	:	402
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4149
Country	:	US
Telephone Number	:	310-843-9532
Fax Number	:

Provider Business Practice Location Address
First Line	:	468 S ROXBURY DR
Second Line	:	402
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-4149
Country	:	US
Telephone Number	:	310-843-9532
Fax Number	:

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

Provider Enumeration Date	:	02/07/2008
Last Update Date	:	02/07/2008

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