MEDICARE: CR DYGERT & CO

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	291U00000X	Clinical Medical Laboratory	05D1085761	CA

General Provider Information

NPI Number	:	1427284934
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CR DYGERT & CO

Provider Business Mailing Address
First Line	:	19528 VENTURA BLVD
Second Line	:	SUITE 649
City	:	TARZANA
State	:	CA
Zip	:	91356-2917
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1335 N LA BREA AVE
Second Line	:	STE 2109
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7526
Country	:	US
Telephone Number	:	323-448-8410
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	CHARLES DYGERT
Credential	:
Telephone Number	:	323-448-8410

Provider Enumeration Date	:	06/10/2009
Last Update Date	:	06/12/2009

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