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NPI Code Detail

MEDICARE: DANA KERT M.A., AMFT 124596

MEDICARE: DANA KERT M.A., AMFT 124596
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
13245S0500XChildren's Substance Abuse Rehabilitation Facility300659BPCA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1D8864690OTHERCASUBSTANCE ABUSE

General Provider Information

NPI Number : 1649851825
Entity Type Code : Individual
Provider Name (Legal Business Name) : DANA KERT M.A., AMFT 124596
Provider Business Mailing Address
First Line : 2750 S HARBOR BLVD STE G
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-5820
Country : US
Telephone Number : 626-643-5378
Fax Number :
Provider Business Practice Location Address
First Line : 2750 S HARBOR BLVD STE G
Second Line :
City : SANTA ANA
State : CA
Zip : 92704-5820
Country : US
Telephone Number : 626-643-5378
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/19/2021
Last Update Date : 04/19/2021

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