MEDICARE: MS. ANA PODINA JESSICA PODINA BS

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	171M00000X	Case Manager/Care Coordinator		CA

General Provider Information

NPI Number	:	1346432689
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANA PODINA JESSICA PODINA BS

Provider Business Mailing Address
First Line	:	651 LENNOX AVE.
Second Line	:	SUITE 400
City	:	VAN NUYS
State	:	CA
Zip	:	90046-9214
Country	:	US
Telephone Number	:	818-989-9217
Fax Number	:	818-989-9217

Provider Business Practice Location Address
First Line	:	6851 LENNOX AVE
Second Line	:	SUITE 400
City	:	VAN NUYS
State	:	CA
Zip	:	91405-4073
Country	:	US
Telephone Number	:	818-989-9217
Fax Number	:	818-989-9217

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

Provider Enumeration Date	:	08/10/2007
Last Update Date	:	08/10/2007

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