MEDICARE: DARIO GHIO MFT INTERN

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	101YM0800X	Mental Health Counselor
2	101YM0800X	Mental Health Counselor	LMFT108955	CA

General Provider Information

NPI Number	:	1043581093
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DARIO GHIO MFT INTERN

Provider Business Mailing Address
First Line	:	1536 W 25TH ST # 257
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90732-4415
Country	:	US
Telephone Number	:	310-707-5520
Fax Number	:

Provider Business Practice Location Address
First Line	:	624 W 9TH ST STE 202
Second Line	:
City	:	SAN PEDRO
State	:	CA
Zip	:	90731-3158
Country	:	US
Telephone Number	:	310-707-5520
Fax Number	:

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

Provider Enumeration Date	:	01/23/2012
Last Update Date	:	01/10/2024

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