MEDICARE: MARY JANE ALUMBAUGH 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	PSY10031	CA

General Provider Information

NPI Number	:	1699089441
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JANE ALUMBAUGH PH.D

Provider Business Mailing Address
First Line	:	301 E COOK ST STE B
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5133
Country	:	US
Telephone Number	:	805-614-0094
Fax Number	:	805-980-4432

Provider Business Practice Location Address
First Line	:	301 E COOK ST STE B
Second Line	:
City	:	SANTA MARIA
State	:	CA
Zip	:	93454-5133
Country	:	US
Telephone Number	:	805-614-0094
Fax Number	:	805-980-4432

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

Provider Enumeration Date	:	08/04/2010
Last Update Date	:	08/04/2010

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