MEDICARE: DR. DEBORA LYNN BURGARD PH.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	103T00000X	Psychologist	PSY13415	CA

General Provider Information

NPI Number	:	1932287521
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBORA LYNN BURGARD PH.D.

Provider Business Mailing Address
First Line	:	5050 EL CAMINO REAL
Second Line	:	SUITE 202
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1530
Country	:	US
Telephone Number	:	650-321-2606
Fax Number	:

Provider Business Practice Location Address
First Line	:	5050 EL CAMINO REAL
Second Line	:	SUITE 202
City	:	LOS ALTOS
State	:	CA
Zip	:	94022-1530
Country	:	US
Telephone Number	:	650-321-2606
Fax Number	:

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

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	07/08/2007

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Directions to “ DR. DEBORA LYNN BURGARD PH.D.” Practice Location

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