MEDICARE: DR. GEORGE JOSEPH REDERICH 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	2084N0400X	Neurology Physician	G36414	CA

General Provider Information

NPI Number	:	1649212309
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GEORGE JOSEPH REDERICH M.D.

Provider Business Mailing Address
First Line	:	520 N PROSPECT AVE
Second Line	:	SUITE 309
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3041
Country	:	US
Telephone Number	:	310-376-9492
Fax Number	:	310-376-0848

Provider Business Practice Location Address
First Line	:	520 N PROSPECT AVE
Second Line	:	SUITE 309
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-3041
Country	:	US
Telephone Number	:	310-376-9492
Fax Number	:	310-376-0848

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

Provider Enumeration Date	:	06/10/2006
Last Update Date	:	07/08/2007

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