MEDICARE: VIKKI CHARLES M.F.C.C.

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	LMFT48499	CA

General Provider Information

NPI Number	:	1134269707
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VIKKI CHARLES M.F.C.C.

Provider Business Mailing Address
First Line	:	9036 ARCADIA AVE APT 5
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91775-1452
Country	:	US
Telephone Number	:	626-253-2698
Fax Number	:

Provider Business Practice Location Address
First Line	:	3569 LEXINGTON AVE
Second Line	:
City	:	EL MONTE
State	:	CA
Zip	:	91731-2607
Country	:	US
Telephone Number	:	626-453-3399
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	03/22/2022

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