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NPI Code Detail

MEDICARE: RICHARD TRAVIESIO

MEDICARE: RICHARD TRAVIESIO
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
1101YA0400XAddiction (Substance Use Disorder) Counselor

General Provider Information

NPI Number : 1356467716
Entity Type Code : Individual
Provider Name (Legal Business Name) : RICHARD TRAVIESIO
Provider Business Mailing Address
First Line : 5715 S BROADWAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-4131
Country : US
Telephone Number : 323-948-0444
Fax Number :
Provider Business Practice Location Address
First Line : 5715 S BROADWAY
Second Line :
City : LOS ANGELES
State : CA
Zip : 90037-4131
Country : US
Telephone Number : 323-948-0444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2007
Last Update Date : 07/08/2007

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Directions to “ RICHARD TRAVIESIO ” Practice Location

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