MEDICARE: DR. MATTHEW JOSEPH ENNA M.D.

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	207X00000X	Orthopaedic Surgery Physician	A100628	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45-2457553	OTHER	CA	CORPORATE TAX ID#

General Provider Information

NPI Number	:	1396797809
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW JOSEPH ENNA M.D.

Provider Business Mailing Address
First Line	:	9033 WILSHIRE BLVD
Second Line	:	SUITE 403
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1837
Country	:	US
Telephone Number	:	310-858-3880
Fax Number	:	888-589-6241

Provider Business Practice Location Address
First Line	:	9033 WILSHIRE BLVD
Second Line	:	SUITE 403
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-1837
Country	:	US
Telephone Number	:	310-858-3880
Fax Number	:	888-589-6241

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

Provider Enumeration Date	:	05/16/2006
Last Update Date	:	09/12/2012

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