MEDICARE: JOHN WILLARD FOX 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	106H00000X	Marriage & Family Therapist	12191	CA

General Provider Information

NPI Number	:	1477729275
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOHN WILLARD FOX PH.D.

Provider Business Mailing Address
First Line	:	2262 HIDALGO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3651
Country	:	US
Telephone Number	:	323-664-2775
Fax Number	:	323-664-2775

Provider Business Practice Location Address
First Line	:	2262 HIDALGO AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-3651
Country	:	US
Telephone Number	:	323-664-2775
Fax Number	:	323-664-2775

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

Provider Enumeration Date	:	05/01/2008
Last Update Date	:	05/01/2008

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