MEDICARE: MS. JULIETTE CAROL LOUISE PINEDA 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	MFC46411	CA

General Provider Information

NPI Number	:	1437175858
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JULIETTE CAROL LOUISE PINEDA LMFT

Provider Business Mailing Address
First Line	:	PO BOX 222
Second Line	:
City	:	LAGUNA BEACH
State	:	CA
Zip	:	92652-0222
Country	:	US
Telephone Number	:	949-637-0635
Fax Number	:

Provider Business Practice Location Address
First Line	:	2730 CAMINO CAPISTRANO
Second Line	:	SUITE 3
City	:	SAN CLEMENTE
State	:	CA
Zip	:	92672-4847
Country	:	US
Telephone Number	:	949-637-0635
Fax Number	:

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

Provider Enumeration Date	:	07/15/2006
Last Update Date	:	12/03/2008

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