MEDICARE: JAMIE ANN ENGWER III M.A., IMF

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	101YM0800X	Mental Health Counselor
2	106H00000X	Marriage & Family Therapist	47983	CA

General Provider Information

NPI Number	:	1851467435
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMIE ANN ENGWER III M.A., IMF

Provider Business Mailing Address
First Line	:	2423 CAMINO DEL RIO S STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3734
Country	:	US
Telephone Number	:	858-405-5510
Fax Number	:	858-405-5510

Provider Business Practice Location Address
First Line	:	2423 CAMINO DEL RIO SOUTH
Second Line	:	SUITE 103
City	:	SAN DIEGO
State	:	CA
Zip	:	92108
Country	:	US
Telephone Number	:	858-405-5510
Fax Number	:	619-293-3746

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

Provider Enumeration Date	:	11/27/2006
Last Update Date	:	02/12/2010

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