MEDICARE: DR. EMMANUEL BRANDEIS M.D.

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	207VG0400X	Gynecology Physician	C38684	CA

General Provider Information

NPI Number	:	1861521478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. EMMANUEL BRANDEIS M.D.

Provider Business Mailing Address
First Line	:	292 S LA CIENEGA BLVD STE 100
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3337
Country	:	US
Telephone Number	:	310-855-7504
Fax Number	:	310-855-7514

Provider Business Practice Location Address
First Line	:	292 S LA CIENEGA BLVD
Second Line	:	100
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90211-3330
Country	:	US
Telephone Number	:	310-855-7504
Fax Number	:	310-855-7514

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

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	12/16/2010

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