MEDICARE: MRS. NOILA R PERRI MFTI

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	60450	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	95-1661119	OTHER	CA	YWCA OF SAN DIEGO COUNTY

General Provider Information

NPI Number	:	1881973121
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. NOILA R PERRI MFTI

Provider Business Mailing Address
First Line	:	1012 C STREET
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101
Country	:	US
Telephone Number	:	619-239-0355
Fax Number	:	619-233-8545

Provider Business Practice Location Address
First Line	:	1012 C ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-5522
Country	:	US
Telephone Number	:	619-239-0355
Fax Number	:	619-233-8545

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

Provider Enumeration Date	:	08/04/2011
Last Update Date	:	08/04/2011

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