MEDICARE: DR. ERICA MONDRO MEYER PSY.D.

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	103G00000X	Clinical Neuropsychologist	PSY20215	CA

General Provider Information

NPI Number	:	1184749889
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA MONDRO MEYER PSY.D.

Provider Business Mailing Address
First Line	:	1902 SHELL AVE
Second Line	:
City	:	VENICE
State	:	CA
Zip	:	90291-3879
Country	:	US
Telephone Number	:	310-948-0734
Fax Number	:	310-285-5068

Provider Business Practice Location Address
First Line	:	1112 OCEAN DR
Second Line	:	SUITE 102
City	:	MANHATTAN BEACH
State	:	CA
Zip	:	90266-5448
Country	:	US
Telephone Number	:	310-948-0734
Fax Number	:	310-285-5068

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

Provider Enumeration Date	:	03/20/2007
Last Update Date	:	07/08/2007

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