MEDICARE: RODNEY BLUESTONE MEDICAL CORPORATION

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	174400000X	Specialist

General Provider Information

NPI Number	:	1447254974
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RODNEY BLUESTONE MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	436 N BEDFORD DR
Second Line	:	STE 303
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4320
Country	:	US
Telephone Number	:	310-657-2222
Fax Number	:	310-550-0367

Provider Business Practice Location Address
First Line	:	436 N BEDFORD DR
Second Line	:	STE 303
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90210-4320
Country	:	US
Telephone Number	:	310-657-2222
Fax Number	:	310-550-0367

Authorized Official
Title or Position	:	OFFICE ADMINISTRATOR
Name	:	HANAN BOTROS
Credential	:
Telephone Number	:	310-657-2222

Provider Enumeration Date	:	06/13/2005
Last Update Date	:	10/15/2008

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