MEDICARE: ROBERT SEAN VAZZANA LMFT

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	112270	CA
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1811231020
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SEAN VAZZANA LMFT

Provider Business Mailing Address
First Line	:	PO BOX 452601
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-8535
Country	:	US
Telephone Number	:	702-279-2877
Fax Number	:

Provider Business Practice Location Address
First Line	:	627 N LARCHMONT BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90004-1307
Country	:	US
Telephone Number	:	323-374-5222
Fax Number	:

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

Provider Enumeration Date	:	11/12/2012
Last Update Date	:	06/08/2022

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