MEDICARE: MS. DAYNA DECRISTOFERI 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	48873	CA

General Provider Information

NPI Number	:	1235578311
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DAYNA DECRISTOFERI LMFT

Provider Business Mailing Address
First Line	:	P.O. BOX 145
Second Line	:
City	:	SOULSBYVILLE
State	:	CA
Zip	:	95372
Country	:	US
Telephone Number	:	209-604-6606
Fax Number	:

Provider Business Practice Location Address
First Line	:	18144 SECO ST
Second Line	:
City	:	JAMESTOWN
State	:	CA
Zip	:	95327-9737
Country	:	US
Telephone Number	:	209-984-4820
Fax Number	:	209-984-4825

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

Provider Enumeration Date	:	06/21/2013
Last Update Date	:	06/21/2013

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