MEDICARE: LORI MUSTO 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	207Q00000X	Family Medicine Physician	20A6735	CA

General Provider Information

NPI Number	:	1760467286
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LORI MUSTO D.O.

Provider Business Mailing Address
First Line	:	881 ALMA REAL DR
Second Line	:	STE 110
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3731
Country	:	US
Telephone Number	:	310-454-1212
Fax Number	:	310-454-2185

Provider Business Practice Location Address
First Line	:	881 ALMA REAL DR
Second Line	:	STE 110
City	:	PACIFIC PALISADES
State	:	CA
Zip	:	90272-3731
Country	:	US
Telephone Number	:	310-454-1212
Fax Number	:	310-454-2185

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

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	05/03/2010

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Directions to “ LORI MUSTO D.O.” Practice Location

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