MEDICARE: MARGIE BASTEDO 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	16737	CA

General Provider Information

NPI Number	:	1912004334
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARGIE BASTEDO MFT

Provider Business Mailing Address
First Line	:	5199 E. PACIFIC COAST HWY
Second Line	:	SUITE 602
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3216
Country	:	US
Telephone Number	:	562-498-7656
Fax Number	:	562-498-7463

Provider Business Practice Location Address
First Line	:	5199 E PACIFIC COAST HWY
Second Line	:	SUITE 602
City	:	LONG BEACH
State	:	CA
Zip	:	90804-3302
Country	:	US
Telephone Number	:	562-498-7656
Fax Number	:	562-498-7463

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

Provider Enumeration Date	:	09/20/2006
Last Update Date	:	07/08/2007

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