MEDICARE: DR. MICHAEL MUSACCO 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	103TC0700X	Clinical Psychologist	14177	CA

General Provider Information

NPI Number	:	1255742581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL MUSACCO PH.D.

Provider Business Mailing Address
First Line	:	5401 BUSINESS PARK S STE 126
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0714
Country	:	US
Telephone Number	:	661-869-2610
Fax Number	:	661-869-2611

Provider Business Practice Location Address
First Line	:	5401 BUSINESS PARK S STE 126
Second Line	:
City	:	BAKERSFIELD
State	:	CA
Zip	:	93309-0714
Country	:	US
Telephone Number	:	661-869-2610
Fax Number	:	661-869-2611

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

Provider Enumeration Date	:	05/08/2014
Last Update Date	:	05/08/2014

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