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NPI Code Detail

MEDICARE: RITA BANEVICIENE

MEDICARE: RITA BANEVICIENE
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
12471S1302XSonography Radiologic TechnologistRDMS113174CA

General Provider Information

NPI Number : 1780997528
Entity Type Code : Individual
Provider Name (Legal Business Name) : RITA BANEVICIENE
Provider Business Mailing Address
First Line : 4059 E OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-3330
Country : US
Telephone Number : 323-881-9444
Fax Number :
Provider Business Practice Location Address
First Line : 4059 E OLYMPIC BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90023-3330
Country : US
Telephone Number : 323-881-9444
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2010
Last Update Date : 07/21/2010

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Directions to “ RITA BANEVICIENE ” Practice Location

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