MEDICARE: DR. DEBRA LYNN ZILAVY 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	PSY14110	CA

General Provider Information

NPI Number	:	1497868574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA LYNN ZILAVY PH.D.

Provider Business Mailing Address
First Line	:	1330 N DUTTON AVE
Second Line	:	SUITE 100
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4674
Country	:	US
Telephone Number	:	707-525-8306
Fax Number	:	707-526-8319

Provider Business Practice Location Address
First Line	:	1330 N DUTTON AVE
Second Line	:	SUITE 100
City	:	SANTA ROSA
State	:	CA
Zip	:	95401-4674
Country	:	US
Telephone Number	:	707-525-8306
Fax Number	:	707-526-8319

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

Provider Enumeration Date	:	08/16/2006
Last Update Date	:	07/09/2007

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