MEDICARE: CENTER FOR BIO-BEHAVIORAL SCIENCE MEDICAL CORPORATION

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	2084P0805X	Geriatric Psychiatry Physician	G32379	CA

General Provider Information

NPI Number	:	1841465622
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR BIO-BEHAVIORAL SCIENCE MEDICAL CORPORATION

Provider Business Mailing Address
First Line	:	2080 CENTURY PARK E
Second Line	:	308
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	310-556-0970
Fax Number	:	310-556-1014

Provider Business Practice Location Address
First Line	:	2080 CENTURY PARK E
Second Line	:	308
City	:	LOS ANGELES
State	:	CA
Zip	:	90067-2006
Country	:	US
Telephone Number	:	310-556-0970
Fax Number	:	310-556-1014

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	DR. RONALD MARK PODELL
Credential	:	M.D.
Telephone Number	:	310-556-1013

Provider Enumeration Date	:	04/23/2008
Last Update Date	:	04/24/2008

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