MEDICARE: DR. LAURENE MASCOLA 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	208000000X	Pediatrics Physician	G32911	CA

General Provider Information

NPI Number	:	1952508228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAURENE MASCOLA MD

Provider Business Mailing Address
First Line	:	4537 LOMA VISTA DR
Second Line	:
City	:	LA CANADA
State	:	CA
Zip	:	91011-2132
Country	:	US
Telephone Number	:	213-240-7941
Fax Number	:	213-482-4856

Provider Business Practice Location Address
First Line	:	313 N FIGUEROA ST RM 212
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90012-2602
Country	:	US
Telephone Number	:	213-240-7941
Fax Number	:	213-482-4856

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

Provider Enumeration Date	:	06/29/2007
Last Update Date	:	07/08/2007

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