MEDICARE: MICHAEL DAVID WERNER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	R1371981119

General Provider Information

NPI Number	:	1225676422
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL DAVID WERNER

Provider Business Mailing Address
First Line	:	1020 S SHERBOURNE DR APT 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2144
Country	:	US
Telephone Number	:	310-866-7910
Fax Number	:

Provider Business Practice Location Address
First Line	:	1020 S SHERBOURNE DR APT 301
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-2144
Country	:	US
Telephone Number	:	310-866-7910
Fax Number	:

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

Provider Enumeration Date	:	12/18/2019
Last Update Date	:	12/18/2019

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Directions to “ MICHAEL DAVID WERNER ” Practice Location

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