MEDICARE: MARK LEWIS SCHUSTER M.A., 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	MFC 8829	CA

General Provider Information

NPI Number	:	1922134360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK LEWIS SCHUSTER M.A., MFT

Provider Business Mailing Address
First Line	:	PO BOX 4798
Second Line	:
City	:	KAILUA KONA
State	:	HI
Zip	:	96745-4798
Country	:	US
Telephone Number	:	808-987-0841
Fax Number	:

Provider Business Practice Location Address
First Line	:	3645 RUFFIN RD
Second Line	:	STE. 205
City	:	SAN DIEGO
State	:	CA
Zip	:	92123-1845
Country	:	US
Telephone Number	:	808-987-0841
Fax Number	:

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

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	07/08/2007

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