MEDICARE: DR. ELVA LYNN DREISBACH MD

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	207R00000X	Internal Medicine Physician	G074704	CA

General Provider Information

NPI Number	:	1952377913
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ELVA LYNN DREISBACH MD

Provider Business Mailing Address
First Line	:	2232 SEPULVEDA BLVD
Second Line	:
City	:	TORRANCE
State	:	CA
Zip	:	90501
Country	:	US
Telephone Number	:	310-257-2598
Fax Number	:	310-326-3605

Provider Business Practice Location Address
First Line	:	2232 SEPULVEDA BLVD
Second Line	:	HEALTHCARE PARTNERS
City	:	TORRANCE
State	:	CA
Zip	:	90501-5301
Country	:	US
Telephone Number	:	310-257-2598
Fax Number	:	310-326-3605

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

Provider Enumeration Date	:	02/28/2006
Last Update Date	:	10/17/2012

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