MEDICARE: DR. BARBARA NOSAL MFT

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	39207	CA

General Provider Information

NPI Number	:	1386773109
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BARBARA NOSAL MFT

Provider Business Mailing Address
First Line	:	PO BOX 3251
Second Line	:
City	:	LA JOLLA
State	:	CA
Zip	:	92038-3251
Country	:	US
Telephone Number	:	619-543-9850
Fax Number	:	619-543-9491

Provider Business Practice Location Address
First Line	:	4080 CENTRE ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-2655
Country	:	US
Telephone Number	:	619-543-9850
Fax Number	:	619-543-9491

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

Provider Enumeration Date	:	03/05/2007
Last Update Date	:	07/08/2007

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