MEDICARE: RENE ARMANDO FRESCAS BS

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1548487176
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RENE ARMANDO FRESCAS BS

Provider Business Mailing Address
First Line	:	1037 OBISPO AVE
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3833
Country	:	US
Telephone Number	:	562-434-0622
Fax Number	:

Provider Business Practice Location Address
First Line	:	506 E FAIRVIEW AVE APT A
Second Line	:
City	:	SAN GABRIEL
State	:	CA
Zip	:	91776-3039
Country	:	US
Telephone Number	:	626-309-0552
Fax Number	:

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

Provider Enumeration Date	:	04/18/2007
Last Update Date	:	07/08/2007

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