MEDICARE: MRS. FERN MULTZ PIETRUSZKA PA-C, MPH

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	363AM0700X	Medical Physician Assistant	10821	CA

General Provider Information

NPI Number	:	1568419133
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. FERN MULTZ PIETRUSZKA PA-C, MPH

Provider Business Mailing Address
First Line	:	5086 AVENIDA HACIENDA
Second Line	:
City	:	TARZANA
State	:	CA
Zip	:	91356-4223
Country	:	US
Telephone Number	:	818-891-1771
Fax Number	:	818-895-9469

Provider Business Practice Location Address
First Line	:	16111 PLUMMER ST
Second Line	:	BUILDING 99, CARE PROGRAM, G-63
City	:	NORTH HILLS
State	:	CA
Zip	:	91343-2036
Country	:	US
Telephone Number	:	818-891-7711
Fax Number	:	818-895-9469

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

Provider Enumeration Date	:	05/28/2006
Last Update Date	:	07/08/2007

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