MEDICARE: DR. LISIANA RUSLI DDS

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	1223G0001X	General Practice Dentistry	41533	CA

General Provider Information

NPI Number	:	1316043920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LISIANA RUSLI DDS

Provider Business Mailing Address
First Line	:	1240 N HACIENDA BLVD STE 103
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-1663
Country	:	US
Telephone Number	:	626-931-2525
Fax Number	:	626-931-2527

Provider Business Practice Location Address
First Line	:	1240 N HACIENDA BLVD STE 103
Second Line	:
City	:	LA PUENTE
State	:	CA
Zip	:	91744-1663
Country	:	US
Telephone Number	:	626-931-2525
Fax Number	:	626-931-2527

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

Provider Enumeration Date	:	09/15/2006
Last Update Date	:	07/08/2007

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