MEDICARE: JULIE ANDERSON RDH

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	124Q00000X	Dental Hygienist	20768	CA

General Provider Information

NPI Number	:	1487906970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JULIE ANDERSON RDH

Provider Business Mailing Address
First Line	:	1200 N VERMONT AVE
Second Line	:	SUITE C
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1760
Country	:	US
Telephone Number	:	323-906-9066
Fax Number	:	323-666-8036

Provider Business Practice Location Address
First Line	:	1200 N VERMONT AVE
Second Line	:	SUITE C
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1760
Country	:	US
Telephone Number	:	323-906-9066
Fax Number	:	323-666-8036

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

Provider Enumeration Date	:	10/08/2012
Last Update Date	:	10/08/2012

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