MEDICARE: MS. KARINA L BEDOLLA 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	86260	CA

General Provider Information

NPI Number	:	1558481143
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KARINA L BEDOLLA MFT

Provider Business Mailing Address
First Line	:	PO BOX 609001
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92160-9001
Country	:	US
Telephone Number	:	619-528-4600
Fax Number	:	619-528-4625

Provider Business Practice Location Address
First Line	:	9620 CHESAPEAKE DR
Second Line	:	STE. 206
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1369
Country	:	US
Telephone Number	:	619-814-6590
Fax Number	:	619-814-6591

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

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	10/23/2015

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