MEDICARE: DENNIS R MACERI 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	207YX0007X	Plastic Surgery within the Head & Neck (Otolaryngology) Physician	G37967	CA

General Provider Information

NPI Number	:	1649297359
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DENNIS R MACERI M.D.

Provider Business Mailing Address
First Line	:	1520 SAN PABLO ST
Second Line	:	SUITE 4600
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5310
Country	:	US
Telephone Number	:	323-442-5790
Fax Number	:

Provider Business Practice Location Address
First Line	:	1520 SAN PABLO ST
Second Line	:	SUITE 4600
City	:	LOS ANGELES
State	:	CA
Zip	:	90033-5310
Country	:	US
Telephone Number	:	323-442-5790
Fax Number	:

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

Provider Enumeration Date	:	07/17/2006
Last Update Date	:	11/20/2013

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