MEDICARE: MRS. JUDIANN RGOEI DAKOSKE MA

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	106H00000X	Marriage & Family Therapist	MFC31806	CA

General Provider Information

NPI Number	:	1376611061
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JUDIANN RGOEI DAKOSKE MA

Provider Business Mailing Address
First Line	:	4055 E THOUSAND OAKS BLVD
Second Line	:	STE. 215
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3600
Country	:	US
Telephone Number	:	805-497-7700
Fax Number	:	805-497-7700

Provider Business Practice Location Address
First Line	:	4055 E THOUSAND OAKS BLVD
Second Line	:	STE. 215
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3600
Country	:	US
Telephone Number	:	805-497-7700
Fax Number	:	805-497-7700

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

Provider Enumeration Date	:	12/01/2006
Last Update Date	:	07/08/2007

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