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NPI Code Detail

MEDICARE: PRESCOTT C. RASMUSSEN, M.D.

MEDICARE: PRESCOTT C. RASMUSSEN, 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
1291U00000XClinical Medical Laboratory
2291U00000XClinical Medical LaboratoryG10130CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100G101300OTHERCABLUE SHIELD

General Provider Information

NPI Number : 1659331684
Entity Type Code : Organization
Provider Name (Legal Business Name) : PRESCOTT C. RASMUSSEN, M.D.
Provider Business Mailing Address
First Line : PO BOX 10076
Second Line :
City : VAN NUYS
State : CA
Zip : 91410-0076
Country : US
Telephone Number : 805-578-8300
Fax Number : 805-578-8950
Provider Business Practice Location Address
First Line : 309 W BEVERLY BLVD
Second Line :
City : MONTEBELLO
State : CA
Zip : 90640-4308
Country : US
Telephone Number : 323-725-4211
Fax Number :
Authorized Official
Title or Position : PRESIDENT
Name : PRESCOTT C RASMUSSEN
Credential : MD
Telephone Number : 323-725-4211
Provider Enumeration Date : 03/24/2006
Last Update Date : 08/22/2020

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