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NPI Code Detail

MEDICARE: MRS. ELENA A LABASTIDA MFT INTERN

MEDICARE: MRS. ELENA A LABASTIDA MFT INTERN
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
1106H00000XMarriage & Family Therapist

General Provider Information

NPI Number : 1033361019
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ELENA A LABASTIDA MFT INTERN
Provider Business Mailing Address
First Line : 333 S FARRELL DR
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262-7905
Country : US
Telephone Number : 760-416-1360
Fax Number : 760-416-8407
Provider Business Practice Location Address
First Line : 333 S FARRELL DR
Second Line :
City : PALM SPRINGS
State : CA
Zip : 92262-7905
Country : US
Telephone Number : 760-416-1360
Fax Number : 760-416-8407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/21/2008
Last Update Date : 11/02/2012

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