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NPI Code Detail

MEDICARE: JOHN S VANGEROV M.F.T

MEDICARE: JOHN S VANGEROV M.F.T
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 Therapist36739CA

General Provider Information

NPI Number : 1982896007
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN S VANGEROV M.F.T
Provider Business Mailing Address
First Line : 2750 E WASHINGTON BLVD STE 230
Second Line :
City : PASADENA
State : CA
Zip : 91107-1449
Country : US
Telephone Number : 626-296-8900
Fax Number :
Provider Business Practice Location Address
First Line : 2750 E WASHINGTON BLVD STE 230
Second Line :
City : PASADENA
State : CA
Zip : 91107-1449
Country : US
Telephone Number : 626-296-8900
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2007
Last Update Date : 03/10/2020

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