MEDICARE: MS. ANJU MATHUR M.D.

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	208D00000X	General Practice Physician	A48468	CA

General Provider Information

NPI Number	:	1598964389
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANJU MATHUR M.D.

Provider Business Mailing Address
First Line	:	1212 NORTH VERMONT AVENUE
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1704
Country	:	US
Telephone Number	:	323-661-7661
Fax Number	:	323-661-0747

Provider Business Practice Location Address
First Line	:	1212 N VERMONT AVE
Second Line	:	#101
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1704
Country	:	US
Telephone Number	:	323-661-7661
Fax Number	:	323-661-0747

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

Provider Enumeration Date	:	07/12/2007
Last Update Date	:	07/16/2007

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