MEDICARE: JOHN JOSEPH DIMEO

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	IMF79056	CA

General Provider Information

NPI Number	:	1780967000
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN JOSEPH DIMEO

Provider Business Mailing Address
First Line	:	1035 MARKET ST
Second Line	:	4TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1600
Country	:	US
Telephone Number	:	415-487-3000
Fax Number	:	415-558-9657

Provider Business Practice Location Address
First Line	:	1035 MARKET ST
Second Line	:	4TH FLOOR
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1600
Country	:	US
Telephone Number	:	415-487-3000
Fax Number	:	415-558-9657

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

Provider Enumeration Date	:	09/22/2011
Last Update Date	:	06/30/2014

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