MEDICARE: MILENA RIBEIRO

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	MFC44442	CA

General Provider Information

NPI Number	:	1275663064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILENA RIBEIRO

Provider Business Mailing Address
First Line	:	17324 PARTHENIA ST
Second Line	:
City	:	NORTHRIDGE
State	:	CA
Zip	:	91325-3239
Country	:	US
Telephone Number	:	818-933-1145
Fax Number	:	888-959-1173

Provider Business Practice Location Address
First Line	:	8363 RESEDA BLVD
Second Line	:	#201
City	:	NORTHRIDGE
State	:	CA
Zip	:	91324-4623
Country	:	US
Telephone Number	:	818-933-1145
Fax Number	:	888-959-1173

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

Provider Enumeration Date	:	03/07/2007
Last Update Date	:	10/04/2012

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