MEDICARE: MS. MISCHELLE BERNICE TURNER 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	PA14175	CA
2	363AM0700X	Medical Physician Assistant	PA14175	CA

General Provider Information

NPI Number	:	1700096468
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MISCHELLE BERNICE TURNER PA-C

Provider Business Mailing Address
First Line	:	1743 W 149TH ST UNIT D
Second Line	:
City	:	GARDENA
State	:	CA
Zip	:	90247-2874
Country	:	US
Telephone Number	:	310-715-6990
Fax Number	:

Provider Business Practice Location Address
First Line	:	1800 N LAKE AVE
Second Line	:
City	:	PASADENA
State	:	CA
Zip	:	91104-1228
Country	:	US
Telephone Number	:	626-993-1238
Fax Number	:	626-993-1288

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

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	04/17/2014

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