MEDICARE: MRS. GINA M. LUKES MFT

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	106H00000X	Marriage & Family Therapist	MFC36553	CA

General Provider Information

NPI Number	:	1033277637
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. GINA M. LUKES MFT

Provider Business Mailing Address
First Line	:	5117 COSTA RUSTICO
Second Line	:
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92673-7120
Country	:	US
Telephone Number	:	949-481-5553
Fax Number	:

Provider Business Practice Location Address
First Line	:	3662 KATELLA AVE STE 116
Second Line	:
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3126
Country	:	US
Telephone Number	:	562-431-8822
Fax Number	:	562-431-8875

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	07/08/2007

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