MEDICARE: VALERIA MURADOV KROCAK PSY.D.

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	25765	CA

General Provider Information

NPI Number	:	1649619180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VALERIA MURADOV KROCAK PSY.D.

Provider Business Mailing Address
First Line	:	123 HODENCAMP RD STE 100
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5833
Country	:	US
Telephone Number	:	773-405-3597
Fax Number	:

Provider Business Practice Location Address
First Line	:	123 HODENCAMP RD STE 100
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-5833
Country	:	US
Telephone Number	:	773-405-3597
Fax Number	:

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

Provider Enumeration Date	:	06/18/2013
Last Update Date	:	06/18/2013

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