MEDICARE: DR. SARAH NENA MOURRA MD

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	2084P0800X	Psychiatry Physician	A121584	CA

General Provider Information

NPI Number	:	1487815882
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SARAH NENA MOURRA MD

Provider Business Mailing Address
First Line	:	300 MEDICAL PLZ
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90095-0001
Country	:	US
Telephone Number	:	310-267-2579
Fax Number	:	310-825-3910

Provider Business Practice Location Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-267-2579
Fax Number	:

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

Provider Enumeration Date	:	06/19/2008
Last Update Date	:	08/30/2013

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