MEDICARE: FELIPE LANCASTER

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	4493-R	CA

General Provider Information

NPI Number	:	1952795130
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	FELIPE LANCASTER

Provider Business Mailing Address
First Line	:	530 S LAKE AVE
Second Line	:	SUITE 197
City	:	PASADENA
State	:	CA
Zip	:	91101-3515
Country	:	US
Telephone Number	:	626-817-3085
Fax Number	:

Provider Business Practice Location Address
First Line	:	530 S LAKE AVE
Second Line	:	SUITE 197
City	:	PASADENA
State	:	CA
Zip	:	91101-3515
Country	:	US
Telephone Number	:	626-817-3085
Fax Number	:

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

Provider Enumeration Date	:	03/25/2015
Last Update Date	:	12/01/2015

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Directions to “ FELIPE LANCASTER ” Practice Location

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