MEDICARE: KLARA ELIZA PENNACHIO 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	LMFT113128	CA

General Provider Information

NPI Number	:	1881136786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KLARA ELIZA PENNACHIO LMFT

Provider Business Mailing Address
First Line	:	PO BOX 2546
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93423-2546
Country	:	US
Telephone Number	:	818-813-3903
Fax Number	:

Provider Business Practice Location Address
First Line	:	8850 OLD SANTA ROSA RD
Second Line	:
City	:	ATASCADERO
State	:	CA
Zip	:	93422-5416
Country	:	US
Telephone Number	:	818-813-3903
Fax Number	:

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

Provider Enumeration Date	:	11/08/2016
Last Update Date	:	01/31/2023

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