MEDICARE: ANGELA OLIVER-COMER

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	MFC36650	CA

General Provider Information

NPI Number	:	1942381421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELA OLIVER-COMER

Provider Business Mailing Address
First Line	:	5252 BALBOA AVE
Second Line	:	SUITE 209
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6906
Country	:	US
Telephone Number	:	619-739-3428
Fax Number	:

Provider Business Practice Location Address
First Line	:	5252 BALBOA AVE
Second Line	:	SUITE 209
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6906
Country	:	US
Telephone Number	:	619-739-3428
Fax Number	:

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

Provider Enumeration Date	:	10/18/2006
Last Update Date	:	07/08/2007

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