MEDICARE: RENEE ALENE DUNDAS

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	225A00000X	Music Therapist	05201	CA

General Provider Information

NPI Number	:	1467096172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENEE ALENE DUNDAS

Provider Business Mailing Address
First Line	:	3856 LYCEUM AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4125
Country	:	US
Telephone Number	:	310-962-8497
Fax Number	:

Provider Business Practice Location Address
First Line	:	3856 LYCEUM AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-4125
Country	:	US
Telephone Number	:	310-962-8497
Fax Number	:

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

Provider Enumeration Date	:	11/06/2019
Last Update Date	:	11/06/2019

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Directions to “ RENEE ALENE DUNDAS ” Practice Location

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