MEDICARE: ANDRA E ZASTROW 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	42560	CA

General Provider Information

NPI Number	:	1548387079
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANDRA E ZASTROW LMFT

Provider Business Mailing Address
First Line	:	2431 W MARCH LN
Second Line	:	SUITE 210
City	:	STOCKTON
State	:	CA
Zip	:	95207-8211
Country	:	US
Telephone Number	:	209-774-6990
Fax Number	:	209-774-6990

Provider Business Practice Location Address
First Line	:	2431 W MARCH LN
Second Line	:	SUITE 210
City	:	STOCKTON
State	:	CA
Zip	:	95207-8211
Country	:	US
Telephone Number	:	209-774-6990
Fax Number	:	209-774-6990

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

Provider Enumeration Date	:	03/22/2007
Last Update Date	:	09/18/2015

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Directions to “ ANDRA E ZASTROW LMFT” Practice Location

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