MEDICARE: MS. LISA MARIE RULLI LE

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	225500000X	Respiratory/Developmental/Rehabilitative Specialist/Technologist

General Provider Information

NPI Number	:	1588135487
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. LISA MARIE RULLI LE

Provider Business Mailing Address
First Line	:	12012 WILSHIRE BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1203
Country	:	US
Telephone Number	:	424-245-5407
Fax Number	:

Provider Business Practice Location Address
First Line	:	12012 WILSHIRE BLVD STE 203
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-1203
Country	:	US
Telephone Number	:	424-245-5407
Fax Number	:

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

Provider Enumeration Date	:	12/17/2018
Last Update Date	:	12/17/2018

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