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General NPI Number Information
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NPI Number | 1720379613
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Entity Type | Organization
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Legal Business Name | ODLINX INCORPORATED
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Dates
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Enumeration Date | 04/26/2011
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 39825 PASEO PADRE PKWY STE B
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City | FREMONT
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State | CA
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Zip | 94538-3031
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Country | US
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Telephone | 510-870-0988
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Fax | 510-870-6383
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Provider Business Mailing Address
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Address Line | 39825 PASEO PADRE PKWY STE B
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City | FREMONT
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State | CA
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Zip | 94538-3031
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Country | US
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Telephone | 510-870-0988
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Fax | 510-870-6383
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. DIKLA SHIDLOV-COHEN
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Credential | PSY.D.
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Telephone | 510-870-0988
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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 | PSY21323
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License Number State | CA
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