MEDICARE: MRS. KHARA ELISE RICE MA, MFT

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 43610	CA

General Provider Information

NPI Number	:	1265526958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. KHARA ELISE RICE MA, MFT

Provider Business Mailing Address
First Line	:	4470 BRISBANE WAY
Second Line	:	#2
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-0639
Country	:	US
Telephone Number	:	760-722-3981
Fax Number	:

Provider Business Practice Location Address
First Line	:	4241 JUTLAND DR
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-3663
Country	:	US
Telephone Number	:	858-274-6633
Fax Number	:

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

Provider Enumeration Date	:	10/03/2006
Last Update Date	:	07/08/2007

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