MEDICARE: MS. GLENDA LILLIANA BAEZ LMFT

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	49849	CA

General Provider Information

NPI Number	:	1699821538
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. GLENDA LILLIANA BAEZ LMFT

Provider Business Mailing Address
First Line	:	2801 CAMINO DEL RIO S
Second Line	:	SUITE 211
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3800
Country	:	US
Telephone Number	:	619-799-8031
Fax Number	:	866-275-1761

Provider Business Practice Location Address
First Line	:	2801 CAMINO DEL RIO S
Second Line	:	SUITE 211
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3800
Country	:	US
Telephone Number	:	619-799-8031
Fax Number	:	866-275-1761

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

Provider Enumeration Date	:	01/25/2007
Last Update Date	:	08/01/2011

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