MEDICARE: MS. MELODIE V RADLER VENTURI P.A.

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	363AM0700X	Medical Physician Assistant	10663	CA

General Provider Information

NPI Number	:	1134268998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MELODIE V RADLER VENTURI P.A.

Provider Business Mailing Address
First Line	:	2970 HILLTOP MALL RD STE 203
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-1949
Country	:	US
Telephone Number	:	510-222-8000
Fax Number	:	510-222-2690

Provider Business Practice Location Address
First Line	:	2970 HILLTOP MALL RD STE 203
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-1949
Country	:	US
Telephone Number	:	510-222-8000
Fax Number	:	510-222-2690

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	01/05/2011

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