MEDICARE: DR. WILLIAM C FALZETT JR. PH.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	103T00000X	Psychologist	PSY10876	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1114925526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM C FALZETT JR. PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 962
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95061-0962
Country	:	US
Telephone Number	:	831-454-4971
Fax Number	:	831-454-4663

Provider Business Practice Location Address
First Line	:	1400 EMELINE AVE
Second Line	:
City	:	SANTA CRUZ
State	:	CA
Zip	:	95060-1976
Country	:	US
Telephone Number	:	831-454-4170
Fax Number	:	831-454-4663

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

Provider Enumeration Date	:	07/09/2005
Last Update Date	:	07/28/2017

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