MEDICARE: NAYELI I DEL REAL 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	141682	CA

General Provider Information

NPI Number	:	1104682376
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NAYELI I DEL REAL MFT

Provider Business Mailing Address
First Line	:	81117 FRANCIS AVE
Second Line	:
City	:	INDIO
State	:	CA
Zip	:	92201-2802
Country	:	US
Telephone Number	:	442-279-2335
Fax Number	:

Provider Business Practice Location Address
First Line	:	77564 COUNTRY CLUB DR STE 201
Second Line	:
City	:	PALM DESERT
State	:	CA
Zip	:	92211-0449
Country	:	US
Telephone Number	:	760-702-0095
Fax Number	:

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

Provider Enumeration Date	:	02/26/2024
Last Update Date	:	02/26/2024

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Directions to “ NAYELI I DEL REAL MFT” Practice Location

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