MEDICARE: KAREN LISSETTE LOERA AMFT

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	142182	CA

General Provider Information

NPI Number	:	1679106868
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN LISSETTE LOERA AMFT

Provider Business Mailing Address
First Line	:	4309 3RD AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1407
Country	:	US
Telephone Number	:	619-876-4502
Fax Number	:

Provider Business Practice Location Address
First Line	:	4212 48TH ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92115-4958
Country	:	US
Telephone Number	:	818-669-3022
Fax Number	:

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

Provider Enumeration Date	:	02/17/2020
Last Update Date	:	01/23/2026

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