Healthcare Provider Details

I. General information

NPI: 1487287595
Provider Name (Legal Business Name): ANTHONY HAZDOVAC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 02/19/2020
Certification Date: 02/19/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8767 CARMEL VALLEY RD
CARMEL CA
93923-7958
US

IV. Provider business mailing address

1142 DIVISADERO ST
PACIFIC GROVE CA
93950-5207
US

V. Phone/Fax

Practice location:
  • Phone: 831-582-1017
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: