MEDICARE: MISS KAYLA TRAN MACH 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	LMFT 93339	CA

General Provider Information

NPI Number	:	1215239983
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KAYLA TRAN MACH LMFT

Provider Business Mailing Address
First Line	:	2801 BRISTOL ST STE 200
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-5996
Country	:	US
Telephone Number	:	714-850-8463
Fax Number	:	714-850-8492

Provider Business Practice Location Address
First Line	:	2801 BRISTOL ST STE 200
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-5996
Country	:	US
Telephone Number	:	714-850-8463
Fax Number	:	714-850-8492

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

Provider Enumeration Date	:	11/30/2010
Last Update Date	:	10/25/2021

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