MEDICARE: MIKOL S. DAVIS ED.D.

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	103TC0700X	Clinical Psychologist	PSY 9063	CA

General Provider Information

NPI Number	:	1073525895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIKOL S. DAVIS ED.D.

Provider Business Mailing Address
First Line	:	930 IRWIN ST
Second Line	:	SUITE 215
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3340
Country	:	US
Telephone Number	:	415-459-1203
Fax Number	:

Provider Business Practice Location Address
First Line	:	930 IRWIN ST
Second Line	:	SUITE 215
City	:	SAN RAFAEL
State	:	CA
Zip	:	94901-3340
Country	:	US
Telephone Number	:	415-459-1203
Fax Number	:

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

Provider Enumeration Date	:	08/12/2006
Last Update Date	:	01/29/2013

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Directions to “ MIKOL S. DAVIS ED.D.” Practice Location

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