MEDICARE: DR. KARI TERVO PH.D.

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	103TC0700X	Clinical Psychologist	PSY23273	CA

General Provider Information

NPI Number	:	1619383478
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KARI TERVO PH.D.

Provider Business Mailing Address
First Line	:	407 AVENUE G APT 35
Second Line	:
City	:	REDONDO BEACH
State	:	CA
Zip	:	90277-5920
Country	:	US
Telephone Number	:	310-880-7710
Fax Number	:

Provider Business Practice Location Address
First Line	:	4929 WILSHIRE BLVD STE 510
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90010-3820
Country	:	US
Telephone Number	:	310-880-7710
Fax Number	:

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

Provider Enumeration Date	:	07/01/2014
Last Update Date	:	07/01/2014

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