MEDICARE: MAYA RUFINO LCSW

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	1041C0700X	Clinical Social Worker	82707	CA

General Provider Information

NPI Number	:	1497234058
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAYA RUFINO LCSW

Provider Business Mailing Address
First Line	:	1035 VISTA GRANDE
Second Line	:
City	:	MILLBRAE
State	:	CA
Zip	:	94030-2133
Country	:	US
Telephone Number	:	848-391-9398
Fax Number	:

Provider Business Practice Location Address
First Line	:	1575 OLD BAYSHORE HWY STE 200
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-1616
Country	:	US
Telephone Number	:	408-512-4642
Fax Number	:

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

Provider Enumeration Date	:	08/13/2018
Last Update Date	:	08/13/2018

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