MEDICARE: MR. MARK PINTO M.S., C.G.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	170300000X	Genetic Counselor (M.S.)

General Provider Information

NPI Number	:	1821242165
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MARK PINTO M.S., C.G.C.

Provider Business Mailing Address
First Line	:	310 N SAN VICENTE BLVD
Second Line	:	3RD FLOOR
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1810
Country	:	US
Telephone Number	:	323-423-9373
Fax Number	:	323-423-9399

Provider Business Practice Location Address
First Line	:	310 N SAN VICENTE BLVD
Second Line	:	3RD FLOOR
City	:	WEST HOLLYWOOD
State	:	CA
Zip	:	90048-1810
Country	:	US
Telephone Number	:	323-423-9373
Fax Number	:	323-423-9399

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

Provider Enumeration Date	:	11/13/2008
Last Update Date	:	11/13/2008

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