Individual
LORI RUBENSTEIN FAZZIO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PT
Contact information
Practice address
11835 W OLYMPIC BLVD, SUITE 135E, LOS ANGELES, CA 90064-5001
(310) 401-6410
(310) 312-3637
Mailing address
PO BOX 641428, LOS ANGELES, CA 90064-6428
(310) 401-6410
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
PT 14694
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W16543
MEDICARE CORPORATION GROUP PTAN
CA
01
—
WPT14694A
MEDICARE PTAN
CA
Enumeration date
11/10/2006
Last updated
01/27/2015
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