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General NPI Number Information
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NPI Number | 1487182101
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Entity Type | Individual
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Provider Name | ELENA KOZLOVA PHD
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Gender | Female
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Dates
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Enumeration Date | 05/25/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 1061 EL MONTE AVE STE B
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2396
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Country | US
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Telephone | 831-297-0567
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Fax | 650-966-1807
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Provider Business Mailing Address
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Address Line | 1061 EL MONTE AVE STE B
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City | MOUNTAIN VIEW
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State | CA
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Zip | 94040-2396
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Country | US
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Telephone | 831-297-0567
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Fax | 650-966-1807
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY29195
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License Number State | CA
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