MEDICARE: PATRICK L MULLENS M D INC

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	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	05D0543155	CA

General Provider Information

NPI Number	:	1881038768
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PATRICK L MULLENS M D INC

Provider Business Mailing Address
First Line	:	PO BOX 10076
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91410-0076
Country	:	US
Telephone Number	:	805-578-8300
Fax Number	:	805-578-3911

Provider Business Practice Location Address
First Line	:	6245 DELONGPRE AVENUE
Second Line	:
City	:	HOLLYWOOD
State	:	CA
Zip	:	90028-8253
Country	:	US
Telephone Number	:	323-462-2271
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	PATRICK L MULLENS
Credential	:	MD
Telephone Number	:	805-578-8300

Provider Enumeration Date	:	04/23/2013
Last Update Date	:	04/23/2013

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