MEDICARE: MR. BENJAMIN AARON MEDVED L.M.F.T.

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	MFC 25688	CA

General Provider Information

NPI Number	:	1194813584
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BENJAMIN AARON MEDVED L.M.F.T.

Provider Business Mailing Address
First Line	:	885 N SAN ANTONIO RD STE A
Second Line	:	SUITE A
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1377
Country	:	US
Telephone Number	:	650-996-4048
Fax Number	:

Provider Business Practice Location Address
First Line	:	885 N SAN ANTONIO RD STE A
Second Line	:	SUITE A
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1377
Country	:	US
Telephone Number	:	650-996-4048
Fax Number	:

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

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	07/08/2007

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