MEDICARE: MARC JOSEPH MESTYANEK

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	T3136	OR
2	106H00000X	Marriage & Family Therapist	48264	CA
3	101YM0800X	Mental Health Counselor	00010938	WA

General Provider Information

NPI Number	:	1407908684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARC JOSEPH MESTYANEK

Provider Business Mailing Address
First Line	:	8314 RAYFORD DR
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-2430
Country	:	US
Telephone Number	:	310-259-0458
Fax Number	:

Provider Business Practice Location Address
First Line	:	23041 AVENIDA DE LA CARLOTA FL 4
Second Line	:
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-1511
Country	:	US
Telephone Number	:	714-644-6480
Fax Number	:

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

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	05/13/2026

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