MEDICARE: NATZAYETH EUNICE BARRALES

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	103797	CA
2	106H00000X	Marriage & Family Therapist	69376	CA
3	106H00000X	Marriage & Family Therapist	141119	CA

General Provider Information

NPI Number	:	1750640272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATZAYETH EUNICE BARRALES

Provider Business Mailing Address
First Line	:	15200 VOSE ST
Second Line	:
City	:	VAN NUYS
State	:	CA
Zip	:	91405-2938
Country	:	US
Telephone Number	:	310-351-0089
Fax Number	:

Provider Business Practice Location Address
First Line	:	6053 BRISTOL PKWY
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90230-6601
Country	:	US
Telephone Number	:	310-351-0089
Fax Number	:

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

Provider Enumeration Date	:	05/04/2012
Last Update Date	:	12/14/2023

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