MEDICARE: RA GREENBERG MEDICAL CORP.

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	101Y00000X	Counselor	C-18884	CA

General Provider Information

NPI Number	:	1558450379
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RA GREENBERG MEDICAL CORP.

Provider Business Mailing Address
First Line	:	1831 WILSHIRE BLVD
Second Line	:	#201
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5777
Country	:	US
Telephone Number	:	310-829-0636
Fax Number	:	310-453-1791

Provider Business Practice Location Address
First Line	:	1831 WILSHIRE BLVD
Second Line	:	#201
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-5777
Country	:	US
Telephone Number	:	310-829-0636
Fax Number	:	310-453-1791

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. RICHARD ALAN GREENBERG
Credential	:	M.D.
Telephone Number	:	310-829-0636

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	02/21/2008

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