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NPI Code Detail

MEDICARE: MR. DAVID MARK TAVLIN M.A.

MEDICARE: MR. DAVID MARK TAVLIN M.A.
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 TherapistMFTI 50937CA
2106H00000XMarriage & Family Therapist49146CA

General Provider Information

NPI Number : 1063537348
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DAVID MARK TAVLIN M.A.
Provider Business Mailing Address
First Line : 1328 2ND ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1122
Country : US
Telephone Number : 310-576-1308
Fax Number :
Provider Business Practice Location Address
First Line : 1328 2ND ST
Second Line :
City : SANTA MONICA
State : CA
Zip : 90401-1122
Country : US
Telephone Number : 310-576-1308
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2007
Last Update Date : 03/23/2015

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