MEDICARE: MARYANN VAZ

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	1041C0700X	Clinical Social Worker	LCSW21566	CA

General Provider Information

NPI Number	:	1063954261
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYANN VAZ

Provider Business Mailing Address
First Line	:	11306 HANNUM AVE
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6129
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	11306 HANNUM AVE
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6129
Country	:	US
Telephone Number	:	310-390-4850
Fax Number	:

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

Provider Enumeration Date	:	11/06/2016
Last Update Date	:	11/06/2016

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Directions to “ MARYANN VAZ ” Practice Location

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