MEDICARE: LAWRENCE H. RESNICK, M.D. A PROF CORP

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	261QR0207X	Mobile Mammography Clinic/Center

General Provider Information

NPI Number	:	1316266216
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE H. RESNICK, M.D. A PROF CORP

Provider Business Mailing Address
First Line	:	2901 WILSHIRE BLVD
Second Line	:	SUITE 319
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4901
Country	:	US
Telephone Number	:	310-829-2931
Fax Number	:	310-453-9226

Provider Business Practice Location Address
First Line	:	2901 WILSHIRE BLVD
Second Line	:	SUITE 319
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-4901
Country	:	US
Telephone Number	:	310-829-2931
Fax Number	:	310-453-9226

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. LAWRENCE H RESNICK
Credential	:	M.D.
Telephone Number	:	310-829-2931

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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