MEDICARE: CENTER FOR OCCUPATIONAL HEALTH

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	103TB0200X	Cognitive & Behavioral Psychologist	PSY22492	CA
2	103TP2701X	Group Psychotherapy Psychologist	PSB37064	CA
3	2084P0800X	Psychiatry Physician	A84559	CA

General Provider Information

NPI Number	:	1215289608
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTER FOR OCCUPATIONAL HEALTH

Provider Business Mailing Address
First Line	:	3260 BLUME DR STE 450
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-5203
Country	:	US
Telephone Number	:	510-323-2524
Fax Number	:

Provider Business Practice Location Address
First Line	:	3260 BLUME DR STE 450
Second Line	:
City	:	RICHMOND
State	:	CA
Zip	:	94806-5203
Country	:	US
Telephone Number	:	510-323-2524
Fax Number	:

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	VLADIMIR BOKARIUS
Credential	:	MD
Telephone Number	:	510-323-2524

Provider Enumeration Date	:	10/09/2012
Last Update Date	:	10/09/2012

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