MEDICARE: DR. SHARON ANN TALOVIC 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	101YM0800X	Mental Health Counselor	PSY9674	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY096740	OTHER	CA	MEDI-CAL

General Provider Information

NPI Number	:	1598969032
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHARON ANN TALOVIC PH.D.

Provider Business Mailing Address
First Line	:	23812 HARBOR VISTA DR
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4819
Country	:	US
Telephone Number	:	310-456-7230
Fax Number	:	310-456-7295

Provider Business Practice Location Address
First Line	:	23812 HARBOR VISTA DR
Second Line	:
City	:	MALIBU
State	:	CA
Zip	:	90265-4819
Country	:	US
Telephone Number	:	310-456-7230
Fax Number	:	310-456-7295

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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