MEDICARE: MS. CHERYL L. AVINA MFT

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	48504	CA

General Provider Information

NPI Number	:	1841501582
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL L. AVINA MFT

Provider Business Mailing Address
First Line	:	1200 3RD AVE
Second Line	:	SUITE 916
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4110
Country	:	US
Telephone Number	:	619-236-6386
Fax Number	:	619-533-3459

Provider Business Practice Location Address
First Line	:	1200 3RD AVE
Second Line	:	SUITE 916
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-4110
Country	:	US
Telephone Number	:	619-236-6386
Fax Number	:	619-533-3459

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

Provider Enumeration Date	:	06/28/2010
Last Update Date	:	06/28/2010

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