MEDICARE: ROSITA ESPINA MATULA MA,IMF

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1275651473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSITA ESPINA MATULA MA,IMF

Provider Business Mailing Address
First Line	:	12665 SUNDANCE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2245
Country	:	US
Telephone Number	:	858-538-7740
Fax Number	:	858-538-5100

Provider Business Practice Location Address
First Line	:	12665 SUNDANCE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-2245
Country	:	US
Telephone Number	:	858-538-7740
Fax Number	:	858-538-5100

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

Provider Enumeration Date	:	03/26/2007
Last Update Date	:	07/08/2007

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