MEDICARE: ANDRES COLMENARES AMFT

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	82886	CA

General Provider Information

NPI Number	:	1649423062
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRES COLMENARES AMFT

Provider Business Mailing Address
First Line	:	20310 LAKEMORE DR
Second Line	:
City	:	CANYON COUNTRY
State	:	CA
Zip	:	91351-1059
Country	:	US
Telephone Number	:	818-281-7066
Fax Number	:

Provider Business Practice Location Address
First Line	:	16360 ROSCOE BLVD
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91406-1219
Country	:	US
Telephone Number	:	818-901-4830
Fax Number	:	818-373-4830

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

Provider Enumeration Date	:	10/29/2008
Last Update Date	:	08/24/2020

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