MEDICARE: PATRICK T. BEZDEK M.D., INC.

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	261QM0850X	Adult Mental Health Clinic/Center	G27084	CA

General Provider Information

NPI Number	:	1174703839
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK T. BEZDEK M.D., INC.

Provider Business Mailing Address
First Line	:	11980 SAN VICENTE BLVD STE 904
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6607
Country	:	US
Telephone Number	:	310-820-2995
Fax Number	:	310-454-2587

Provider Business Practice Location Address
First Line	:	11980 SAN VICENTE BLVD STE 904
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-6607
Country	:	US
Telephone Number	:	310-820-2995
Fax Number	:	310-454-2587

Authorized Official
Title or Position	:	OWNER
Name	:	DR. PATRICK T. BEZDEK
Credential	:	M.D.
Telephone Number	:	310-820-2995

Provider Enumeration Date	:	11/10/2007
Last Update Date	:	11/10/2007

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