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NPI Code Detail

MEDICARE: RILEY LYNN BOZICH ASSOCIATE MFT

MEDICARE: RILEY LYNN BOZICH ASSOCIATE MFT
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
1101YM0800XMental Health CounselorAMFT100665CA
2106H00000XMarriage & Family Therapist162217CA
3106H00000XMarriage & Family Therapist139512CA
4106H00000XMarriage & Family Therapist100665CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
17667OTHERCAMEDI-CAL
27708OTHERCAMEDI-CAL
37184OTHERCAMEDI-CAL
47368OTHERCAMEDI-CAL

General Provider Information

NPI Number : 1922596980
Entity Type Code : Individual
Provider Name (Legal Business Name) : RILEY LYNN BOZICH ASSOCIATE MFT
Provider Business Mailing Address
First Line : 205 PASADENA AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2919
Country : US
Telephone Number : 323-344-5536
Fax Number :
Provider Business Practice Location Address
First Line : 205 PASADENA AVE
Second Line :
City : SOUTH PASADENA
State : CA
Zip : 91030-2919
Country : US
Telephone Number : 323-344-5536
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/25/2018
Last Update Date : 03/12/2026

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