MEDICARE: MRS. LETTY N MESKIN MFT

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	MFC22354	CA

General Provider Information

NPI Number	:	1003836578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LETTY N MESKIN MFT

Provider Business Mailing Address
First Line	:	1205 PACIFIC HWY
Second Line	:	#1902
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-3327
Country	:	US
Telephone Number	:	760-940-0880
Fax Number	:	760-930-9157

Provider Business Practice Location Address
First Line	:	2831 CAMINO DEL RIO S
Second Line	:	STE. 211
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3802
Country	:	US
Telephone Number	:	760-940-0880
Fax Number	:

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

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	07/08/2007

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