MEDICARE: FIDI MWERO 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	LMFT108777	CA

General Provider Information

NPI Number	:	1891279345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FIDI MWERO LMFT

Provider Business Mailing Address
First Line	:	PO BOX 14602
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-0602
Country	:	US
Telephone Number	:	909-255-7181
Fax Number	:

Provider Business Practice Location Address
First Line	:	2275 MARKET ST STE E
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94114-1652
Country	:	US
Telephone Number	:	415-659-8282
Fax Number	:

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

Provider Enumeration Date	:	09/20/2018
Last Update Date	:	02/11/2022

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