| Full Name | |
|---|---|
| Speciality | Psychologist |
| Location | 219 North Hall, Davis, California |
| Authorized Official Name and Position | Emil Rodolfa (DIRECTOR) |
| Authorized Official Contact | 5307520871 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1 Shields Ave Davis CA 95616-5270 Ph: (530) 752-0871 | 219 North Hall Davis CA 95616 Ph: (530) 752-0871 |
| NPI Number | 1427216167 |
|---|---|
| Provider Enumeration Date | 05/29/2008 |
| Last Update Date | 05/29/2008 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1427216167 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103T00000X | Psychologist | PSY8989 (California) | Primary |
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