MEDICARE: MRS. RICHARD KASTANIAS SR.

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	MFC31580	CA

General Provider Information

NPI Number	:	1174671325
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RICHARD KASTANIAS SR.

Provider Business Mailing Address
First Line	:	954 23RD ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92102-1914
Country	:	US
Telephone Number	:	619-417-4923
Fax Number	:	619-294-8190

Provider Business Practice Location Address
First Line	:	591 CAMINO DE LA REINA
Second Line	:	SUITE 918
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3102
Country	:	US
Telephone Number	:	619-417-4923
Fax Number	:	619-294-8190

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

Provider Enumeration Date	:	01/06/2007
Last Update Date	:	07/08/2007

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