MEDICARE: DR. JOEL G. AUERBACH M.D.

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	208000000X	Pediatrics Physician	G068087	CA

General Provider Information

NPI Number	:	1083794143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOEL G. AUERBACH M.D.

Provider Business Mailing Address
First Line	:	5353 BALBOA BLVD
Second Line	:	#200
City	:	ENCINO
State	:	CA
Zip	:	91316-2804
Country	:	US
Telephone Number	:	818-461-9690
Fax Number	:	818-461-9482

Provider Business Practice Location Address
First Line	:	5353 BALBOA BLVD
Second Line	:	#200
City	:	ENCINO
State	:	CA
Zip	:	91316-2804
Country	:	US
Telephone Number	:	818-461-9690
Fax Number	:	818-461-9482

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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