MEDICARE: VICTORIA MCKENZIE STEWART CMT

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	174H00000X	Health Educator	7363-00	VA

General Provider Information

NPI Number	:	1609144906
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA MCKENZIE STEWART CMT

Provider Business Mailing Address
First Line	:	3128 CLINTON AVE
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94804-1416
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	333 MILLER AVE
Second Line	:
City	:	MILL VALLEY
State	:	CA
Zip	:	94941-2846
Country	:	US
Telephone Number	:	510-232-4557
Fax Number	:

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

Provider Enumeration Date	:	12/01/2011
Last Update Date	:	12/01/2011

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