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24050 Madison St Ste 217 Torrance CA 90505-6017 | |
| (310) 463-6638 | |
| (310) 373-4564 |
| Full Name | |
|---|---|
| Speciality | Marriage & Family Therapist |
| Location | 24050 Madison St Ste 217, Torrance, California |
| Authorized Official Name and Position | Meghan Tracy (BILLING/CREDENTIALING) |
| Authorized Official Contact | 9494338023 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
24050 Madison St Ste 217 Torrance CA 90505-6017 Ph: () - | 24050 Madison St Ste 217 Torrance CA 90505-6017 Ph: (310) 463-6638 |
| NPI Number | 1255030649 |
|---|---|
| Provider Enumeration Date | 02/24/2023 |
| Last Update Date | 11/15/2023 |
| Certification Date | 11/15/2023 |
| Medicare PECOS PAC ID | 9830540699 |
|---|---|
| Medicare Enrollment ID | O20240807003155 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255030649 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 106H00000X | Marriage & Family Therapist | (* (Not Available)) | Primary |
| Provider Name | Albert George Potash |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1700958774 PECOS PAC ID: 0749631505 Enrollment ID: I20240821002226 |
| Provider Name | Dianna Velasquez Luna |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1235776642 PECOS PAC ID: 4688115959 Enrollment ID: I20240926001892 |
| Provider Name | Barbara Ann Mignosi |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1689729667 PECOS PAC ID: 9739610494 Enrollment ID: I20241004001746 |
| Provider Name | Colette Connors Esparza |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1043353485 PECOS PAC ID: 6002347796 Enrollment ID: I20241004003189 |
| Provider Name | Marion E Berg |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1417027392 PECOS PAC ID: 1658722418 Enrollment ID: I20241007000516 |
| Provider Name | Jodie Marholz |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1891947511 PECOS PAC ID: 2466983002 Enrollment ID: I20241007001336 |
| Provider Name | Joanna Dianne Garcia |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1932882313 PECOS PAC ID: 1052842697 Enrollment ID: I20241007001569 |
| Provider Name | Vanesa Lorraine Nunez |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1942942230 PECOS PAC ID: 0345771911 Enrollment ID: I20241007002692 |
| Provider Name | James A Stump |
|---|---|
| Provider Type | Practitioner - Marriage And Family Therapist |
| Provider Identifiers | NPI Number: 1992074520 PECOS PAC ID: 2365973880 Enrollment ID: I20241008000768 |
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