MEDICARE: MS. JANA V. PLASTERS 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	MFC34620	CA

General Provider Information

NPI Number	:	1518007103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JANA V. PLASTERS MFT

Provider Business Mailing Address
First Line	:	679 S NEW HAMPSHIRE AVE
Second Line	:	FIFTH FLOOR - PORTALS
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2578
Fax Number	:	213-385-9246

Provider Business Practice Location Address
First Line	:	679 S NEW HAMPSHIRE AVE
Second Line	:	FIFTH FLOOR - PORTALS
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-1355
Country	:	US
Telephone Number	:	213-639-2578
Fax Number	:	213-385-9246

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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