MEDICARE: ELIZABETH V TATE

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	LMFT83318	CA

General Provider Information

NPI Number	:	1063694834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH V TATE

Provider Business Mailing Address
First Line	:	3093 CENTRAL AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-4030
Country	:	US
Telephone Number	:	619-665-7925
Fax Number	:	619-284-2443

Provider Business Practice Location Address
First Line	:	3093 CENTRAL AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92105-4030
Country	:	US
Telephone Number	:	619-665-7925
Fax Number	:	619-284-2443

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

Provider Enumeration Date	:	12/03/2007
Last Update Date	:	11/17/2014

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