Healthcare Provider Details

I. General information

NPI: 1114925526
Provider Name (Legal Business Name): WILLIAM C FALZETT JR. PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2005
Last Update Date: 07/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1400 EMELINE AVE
SANTA CRUZ CA
95060-1976
US

IV. Provider business mailing address

PO BOX 962
SANTA CRUZ CA
95061-0962
US

V. Phone/Fax

Practice location:
  • Phone: 831-454-4170
  • Fax: 831-454-4663
Mailing address:
  • Phone: 831-454-4971
  • Fax: 831-454-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY10876
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: