MEDICARE: PERLA HOLLOW LMFT

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	85915	CA

General Provider Information

NPI Number	:	1124311782
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PERLA HOLLOW LMFT

Provider Business Mailing Address
First Line	:	1230 ROSECRANS AVE STE 300
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2494
Country	:	US
Telephone Number	:	310-265-6540
Fax Number	:

Provider Business Practice Location Address
First Line	:	1230 ROSECRANS AVE STE 300
Second Line	:
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-2494
Country	:	US
Telephone Number	:	310-265-6540
Fax Number	:

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

Provider Enumeration Date	:	05/16/2011
Last Update Date	:	08/03/2020

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