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NPI Code Detail

MEDICARE: DR. TINA KLATT ROSOLACK TRAXLER PH.D.

MEDICARE: DR. TINA KLATT ROSOLACK TRAXLER 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
1103T00000XPsychologist19137CA
2103T00000XPsychologistPSY 19137CA

General Provider Information

NPI Number : 1598871915
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TINA KLATT ROSOLACK TRAXLER PH.D.
Provider Business Mailing Address
First Line : 5445 LAUREL HILLS DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-3105
Country : US
Telephone Number : 916-609-5100
Fax Number : 916-609-5161
Provider Business Practice Location Address
First Line : 5445 LAUREL HILLS DR
Second Line :
City : SACRAMENTO
State : CA
Zip : 95841-3105
Country : US
Telephone Number : 916-609-5100
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/21/2006
Last Update Date : 02/02/2021

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