MEDICARE: DR. MARK ALLEN KAUPP PSY.D.

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	MFC33213	CA

General Provider Information

NPI Number	:	1346236445
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARK ALLEN KAUPP PSY.D.

Provider Business Mailing Address
First Line	:	5452 REDDING RD
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-1133
Country	:	US
Telephone Number	:	619-665-5590
Fax Number	:	619-297-4496

Provider Business Practice Location Address
First Line	:	2835 CAMINO DEL RIO S
Second Line	:	SUITE 120-C
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3825
Country	:	US
Telephone Number	:	619-665-5590
Fax Number	:	619-297-4496

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

Provider Enumeration Date	:	09/23/2005
Last Update Date	:	07/08/2007

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