MEDICARE: SANDRA MAE TERIFAJ

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	LMFT23231	CA

General Provider Information

NPI Number	:	1194479428
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SANDRA MAE TERIFAJ

Provider Business Mailing Address
First Line	:	11662 EVENING SKY DR
Second Line	:
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-2031
Country	:	US
Telephone Number	:	714-319-5342
Fax Number	:

Provider Business Practice Location Address
First Line	:	11662 EVENING SKY DR
Second Line	:
City	:	DESERT HOT SPRINGS
State	:	CA
Zip	:	92240-2031
Country	:	US
Telephone Number	:	714-319-5342
Fax Number	:

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

Provider Enumeration Date	:	02/06/2022
Last Update Date	:	02/06/2022

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Directions to “ SANDRA MAE TERIFAJ ” Practice Location

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