MEDICARE: DR. DAFNA TRITES D.O.

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	207VG0400X	Gynecology Physician	20A6852	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1699734319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAFNA TRITES D.O.

Provider Business Mailing Address
First Line	:	PO BOX 9602
Second Line	:
City	:	MISSION HILLS
State	:	CA
Zip	:	91346-9602
Country	:	US
Telephone Number	:	818-837-5559
Fax Number	:	818-792-4793

Provider Business Practice Location Address
First Line	:	18460 ROSCOE BLVD
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-4107
Country	:	US
Telephone Number	:	818-734-3600
Fax Number	:

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

Provider Enumeration Date	:	03/21/2006
Last Update Date	:	06/16/2016

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