MEDICARE: MS. MYRIAM POPLAWSKY EASTON 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	MFC38848	CA

General Provider Information

NPI Number	:	1164459111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MYRIAM POPLAWSKY EASTON MFT

Provider Business Mailing Address
First Line	:	3939 EAGLE ST
Second Line	:	#107
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2974
Country	:	US
Telephone Number	:	619-517-7618
Fax Number	:

Provider Business Practice Location Address
First Line	:	2667 CAMINO DEL RIO S
Second Line	:	STE # 301-12
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3707
Country	:	US
Telephone Number	:	619-517-7618
Fax Number	:

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

Provider Enumeration Date	:	06/26/2006
Last Update Date	:	07/17/2008

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