MEDICARE: MISS MICHELLE MARIE COX

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PSY25090	CA

General Provider Information

NPI Number	:	1033231071
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS MICHELLE MARIE COX

Provider Business Mailing Address
First Line	:	2412 PROFESSIONAL DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-7773
Country	:	US
Telephone Number	:	858-361-1372
Fax Number	:

Provider Business Practice Location Address
First Line	:	2412 PROFESSIONAL DR
Second Line	:
City	:	ROSEVILLE
State	:	CA
Zip	:	95661-7773
Country	:	US
Telephone Number	:	858-361-1372
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2007
Last Update Date	:	10/29/2015

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