MEDICARE: DR. NEAL SELIM ELATTRACHE MD

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	207XX0005X	Sports Medicine (Orthopaedic Surgery) Physician	068481	CA

General Provider Information

NPI Number	:	1669457354
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NEAL SELIM ELATTRACHE MD

Provider Business Mailing Address
First Line	:	6801 PARK TER
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1543
Country	:	US
Telephone Number	:	310-665-7200
Fax Number	:	310-665-7138

Provider Business Practice Location Address
First Line	:	6801 PARK TER
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-1543
Country	:	US
Telephone Number	:	310-665-7200
Fax Number	:	310-665-7138

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	07/08/2007

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