MEDICARE: MR. AURELIO EZEQUIEL AGUNDEZ 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	17669	CA

General Provider Information

NPI Number	:	1528108172
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. AURELIO EZEQUIEL AGUNDEZ MFT

Provider Business Mailing Address
First Line	:	11741 TELEGRAPH RD
Second Line	:	SUITE G
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3681
Country	:	US
Telephone Number	:	562-942-8256
Fax Number	:	562-942-9789

Provider Business Practice Location Address
First Line	:	11741 TELEGRAPH RD
Second Line	:	SUITE G
City	:	SANTA FE SPRINGS
State	:	CA
Zip	:	90670-3681
Country	:	US
Telephone Number	:	562-942-8256
Fax Number	:	562-942-9789

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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