MEDICARE: MRS. TINA AHDOOT PA-C

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	363A00000X	Physician Assistant	PA20655	CA

General Provider Information

NPI Number	:	1699044966
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TINA AHDOOT PA-C

Provider Business Mailing Address
First Line	:	9201 W SUNSET BLVD STE 705
Second Line	:
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90069-3708
Country	:	US
Telephone Number	:	310-271-2744
Fax Number	:

Provider Business Practice Location Address
First Line	:	9201 W SUNSET BLVD STE 705
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-3708
Country	:	US
Telephone Number	:	310-271-2744
Fax Number	:

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

Provider Enumeration Date	:	12/15/2011
Last Update Date	:	05/09/2014

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