MEDICARE: WAKING UP ON THE TOILET

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
2	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1417188871
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WAKING UP ON THE TOILET

Provider Business Mailing Address
First Line	:	1126 N 2ND ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-5008
Country	:	US
Telephone Number	:	619-447-0910
Fax Number	:	619-201-8466

Provider Business Practice Location Address
First Line	:	1126 N 2ND ST
Second Line	:
City	:	EL CAJON
State	:	CA
Zip	:	92021-5008
Country	:	US
Telephone Number	:	619-438-0237
Fax Number	:	619-201-8466

Authorized Official
Title or Position	:	COUNSELOR
Name	:	MRS. ALIYA FONSECA
Credential	:	LMFT
Telephone Number	:	858-373-7315

Provider Enumeration Date	:	08/04/2009
Last Update Date	:	01/17/2023

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Directions to “WAKING UP ON THE TOILET ” Practice Location

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