MEDICARE: RONNA LYNNE PEARL

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	174400000X	Specialist	L9456	CA

General Provider Information

NPI Number	:	1598272262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RONNA LYNNE PEARL

Provider Business Mailing Address
First Line	:	917 N VENDOME ST
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90026-2816
Country	:	US
Telephone Number	:	323-333-3044
Fax Number	:

Provider Business Practice Location Address
First Line	:	3371 GLENDALE BLVD STE 215
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1857
Country	:	US
Telephone Number	:	323-333-3044
Fax Number	:

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

Provider Enumeration Date	:	01/04/2018
Last Update Date	:	01/04/2018

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Directions to “ RONNA LYNNE PEARL ” Practice Location

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