MEDICARE: MR. PAUL MICHAEL REMMELE 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	90574	CA

General Provider Information

NPI Number	:	1376737213
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PAUL MICHAEL REMMELE LMFT

Provider Business Mailing Address
First Line	:	4031 MCLAUGHLIN AVE
Second Line	:	APT #9
City	:	LOS ANGELES
State	:	CA
Zip	:	90066-5468
Country	:	US
Telephone Number	:	310-570-3490
Fax Number	:	310-306-5717

Provider Business Practice Location Address
First Line	:	10642 SANTA MONICA BLVD
Second Line	:	SUITE #201
City	:	LOS ANGELES
State	:	CA
Zip	:	90025-4525
Country	:	US
Telephone Number	:	310-475-9620
Fax Number	:

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

Provider Enumeration Date	:	09/04/2007
Last Update Date	:	12/18/2015

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