MEDICARE: JUANITA I CARRENO

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	:	1588775316
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JUANITA I CARRENO

Provider Business Mailing Address
First Line	:	28 ORANGE AVE UNIT 4
Second Line	:
City	:	CHULA VISTA
State	:	CA
Zip	:	91911-5155
Country	:	US
Telephone Number	:	619-929-4258
Fax Number	:

Provider Business Practice Location Address
First Line	:	1840 WILSON AVE STE C
Second Line	:
City	:	NATIONAL CITY
State	:	CA
Zip	:	91950-5515
Country	:	US
Telephone Number	:	619-477-0242
Fax Number	:	619-477-0799

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

Provider Enumeration Date	:	08/31/2006
Last Update Date	:	07/08/2007

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