MEDICARE: MR. BORIS SKURATOVICH

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	310400000X	Assisted Living Facility	197608929	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538542360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BORIS SKURATOVICH

Provider Business Mailing Address
First Line	:	3454 PERLITA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1932
Country	:	US
Telephone Number	:	323-665-6893
Fax Number	:	323-658-5533

Provider Business Practice Location Address
First Line	:	3454 PERLITA AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1932
Country	:	US
Telephone Number	:	323-665-6893
Fax Number	:	323-658-5533

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

Provider Enumeration Date	:	06/29/2015
Last Update Date	:	06/29/2015

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Directions to “ MR. BORIS SKURATOVICH ” Practice Location

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