MEDICARE: CAROLINA MEYERLIN SUNO

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	:	1396438933
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROLINA MEYERLIN SUNO

Provider Business Mailing Address
First Line	:	828 CALLA AVE APT B
Second Line	:
City	:	IMPERIAL BEACH
State	:	CA
Zip	:	91932-1570
Country	:	US
Telephone Number	:	619-779-2224
Fax Number	:

Provider Business Practice Location Address
First Line	:	1625 NEWTON AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92113-1012
Country	:	US
Telephone Number	:	619-779-2224
Fax Number	:

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

Provider Enumeration Date	:	05/30/2023
Last Update Date	:	05/30/2023

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Directions to “ CAROLINA MEYERLIN SUNO ” Practice Location

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