MEDICARE: BRIAN KNOLL

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	34502	CA

General Provider Information

NPI Number	:	1699402669
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRIAN KNOLL

Provider Business Mailing Address
First Line	:	3901 LAS POSAS RD STE 208
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1506
Country	:	US
Telephone Number	:	805-678-8359
Fax Number	:	805-244-0465

Provider Business Practice Location Address
First Line	:	3901 LAS POSAS RD STE 208
Second Line	:
City	:	CAMARILLO
State	:	CA
Zip	:	93010-1506
Country	:	US
Telephone Number	:	805-678-8359
Fax Number	:	805-244-0465

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

Provider Enumeration Date	:	08/01/2022
Last Update Date	:	06/10/2026

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Directions to “ BRIAN KNOLL ” Practice Location

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