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NPI Code Detail

MEDICARE: MIRNA BANUELOS LMFT

MEDICARE: MIRNA BANUELOS 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
1106H00000XMarriage & Family TherapistLMFT141796CA

General Provider Information

NPI Number : 1922372044
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIRNA BANUELOS LMFT
Provider Business Mailing Address
First Line : 4760 SEPULVEDA BLVD
Second Line :
City : CULVER CITY
State : CA
Zip : 90230-4820
Country : US
Telephone Number : 310-390-6612
Fax Number : 310-398-5690
Provider Business Practice Location Address
First Line : 221 N ARDMORE AVE
Second Line :
City : LOS ANGELES
State : CA
Zip : 90004-4503
Country : US
Telephone Number : 213-381-3626
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/07/2012
Last Update Date : 01/03/2024

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Directions to “ MIRNA BANUELOS LMFT” Practice Location

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