MEDICARE: MRS. XIOMARA ISABEL CEA MFT-I

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	51322	CA
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1629240775
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. XIOMARA ISABEL CEA MFT-I

Provider Business Mailing Address
First Line	:	1825 POINSETTIA ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-2917
Country	:	US
Telephone Number	:	714-541-6627
Fax Number	:

Provider Business Practice Location Address
First Line	:	1825 POINSETTIA ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-2917
Country	:	US
Telephone Number	:	714-541-6627
Fax Number	:

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

Provider Enumeration Date	:	03/28/2008
Last Update Date	:	03/28/2008

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