MEDICARE: MILO MARK COCCIMIGLIO

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	38917	CA

General Provider Information

NPI Number	:	1851452114
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MILO MARK COCCIMIGLIO

Provider Business Mailing Address
First Line	:	415 HUMBOLDT ST STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4214
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 HUMBOLDT ST STE B
Second Line	:
City	:	SANTA ROSA
State	:	CA
Zip	:	95404-4214
Country	:	US
Telephone Number	:	707-565-7624
Fax Number	:

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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Directions to “ MILO MARK COCCIMIGLIO ” Practice Location

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