MEDICARE: KATARINA MINA TASIC M.D.

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	A67158	CA

General Provider Information

NPI Number	:	1528185949
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATARINA MINA TASIC M.D.

Provider Business Mailing Address
First Line	:	11705 ALAMEDA ST
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4023
Country	:	US
Telephone Number	:	323-568-4677
Fax Number	:	323-568-4650

Provider Business Practice Location Address
First Line	:	11705 ALAMEDA ST
Second Line	:
City	:	LYNWOOD
State	:	CA
Zip	:	90262-4023
Country	:	US
Telephone Number	:	323-568-4677
Fax Number	:	323-568-4650

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	04/01/2013

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