MEDICARE: ANAITE O CACERES M.A., MFT

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	MFC42011	CA

General Provider Information

NPI Number	:	1497962872
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANAITE O CACERES M.A., MFT

Provider Business Mailing Address
First Line	:	21241 VENTURA BLVD STE 246
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2153
Country	:	US
Telephone Number	:	818-263-2390
Fax Number	:

Provider Business Practice Location Address
First Line	:	21241 VENTURA BLVD STE 246
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91364-2153
Country	:	US
Telephone Number	:	818-263-2390
Fax Number	:

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

Provider Enumeration Date	:	05/17/2007
Last Update Date	:	07/03/2014

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