MEDICARE: FIX'D INC.

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

General Provider Information

NPI Number	:	1891348819
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FIX'D INC.

Provider Business Mailing Address
First Line	:	68 E 11TH ST STE 115
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-4089
Country	:	US
Telephone Number	:	209-666-7178
Fax Number	:

Provider Business Practice Location Address
First Line	:	68 E 11TH ST STE 115
Second Line	:
City	:	TRACY
State	:	CA
Zip	:	95376-4089
Country	:	US
Telephone Number	:	209-666-7178
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT / CEO
Name	:	MR. JAIME ALBERT MEDINA
Credential	:
Telephone Number	:	209-207-9284

Provider Enumeration Date	:	07/18/2019
Last Update Date	:	07/18/2019

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Directions to “FIX'D INC. ” Practice Location

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