MEDICARE: SIBEL KANTARCI PH.D., FACMG

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	207SM0001X	Molecular Genetic Pathology (Medical Genetics) Physician	MTP00000395	CA
2	207SC0300X	Clinical Cytogenetics Physician	MTP00000395	CA

General Provider Information

NPI Number	:	1366988834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SIBEL KANTARCI PH.D., FACMG

Provider Business Mailing Address
First Line	:	1010 VETERAN AVENUE, WEST MEDICAL BUILDING, ROOM 2212E
Second Line	:	UCLA CLINICAL AND MOLECULAR CYTOGENETICS LABORATORY
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-825-4965
Fax Number	:	310-794-5099

Provider Business Practice Location Address
First Line	:	1010 VETERAN AVENUE, WEST MEDICAL BUILDING
Second Line	:	UCLA CLINICAL AND MOLECULAR CYTOGENETICS LABORATORY
City	:	LOS ANGELES
State	:	CA
Zip	:	90024
Country	:	US
Telephone Number	:	310-825-4965
Fax Number	:	310-794-5099

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

Provider Enumeration Date	:	01/09/2017
Last Update Date	:	01/09/2017

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