MEDICARE: EVANTHIA ROUSSOS TORRES 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	207R00000X	Internal Medicine Physician	MT201222	PA
2	207RX0202X	Medical Oncology Physician	D80560	MD
3	207RX0202X	Medical Oncology Physician	A166224	CA

General Provider Information

NPI Number	:	1528327632
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EVANTHIA ROUSSOS TORRES M.D.

Provider Business Mailing Address
First Line	:	PO BOX 31309
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90031-0309
Country	:	US
Telephone Number	:	323-865-3105
Fax Number	:

Provider Business Practice Location Address
First Line	:	1441 EASTLAKE AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90089-1221
Country	:	US
Telephone Number	:	323-865-3105
Fax Number	:

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

Provider Enumeration Date	:	05/09/2012
Last Update Date	:	11/27/2023

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