MEDICARE: ROBERT J FOX PHD

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	103TC0700X	Clinical Psychologist	PSY 9073	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY 9073	OTHER	CA	PHD

General Provider Information

NPI Number	:	1578677944
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT J FOX PHD

Provider Business Mailing Address
First Line	:	PO BOX 28824
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92198-0824
Country	:	US
Telephone Number	:	858-487-2713
Fax Number	:	858-487-4741

Provider Business Practice Location Address
First Line	:	11770 BERNARDO PLAZA CT STE 217
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92128-2425
Country	:	US
Telephone Number	:	858-487-2713
Fax Number	:	858-487-4741

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

Provider Enumeration Date	:	08/19/2006
Last Update Date	:	07/09/2007

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