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General NPI Number Information
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NPI Number | 1205052008
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Entity Type | Individual
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Provider Name | BOSILJKA NADIA TOKIC-POLAK MA, MFT
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Gender | Female
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Dates
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Enumeration Date | 04/18/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 240 WESTGATE DR # S-125
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City | WATSONVILLE
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State | CA
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Zip | 95076-2461
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Country | US
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Telephone | 831-425-4411
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Fax |
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Provider Business Mailing Address
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Address Line | 67 FAIRVIEW PLZ APT 3
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City | LOS GATOS
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State | CA
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Zip | 95030-5865
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Country | US
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Telephone | 408-395-4191
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 44133
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License Number State | CA
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