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Individual

THOMAS J. MRAZ

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PH.D.

Contact information

Practice address
20800 WESTGATE MALL, SUITE 103, FAIRVIEW PARK, OH 44126-1323
(831) 901-7790
Mailing address
PO BOX 45075, WESTLAKE, OH 44145-0075
(831) 917-7900

Taxonomy

Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
7441
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
FHC 70042F
MEDI-CAL GROUP PROVIDER#
CA
01
FHC 70044F
MEDI-CAL GROUP PROVIDER#
CA
01
PSY 20869
PSYCHOLOGIST LICENSE
CA
01
ZZZ91891Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
ZZZ91892Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
01
ZZZ92069Z
SANTA CRUZ COUNTY MEDICARE GROUP PTAN#
CA
Enumeration date
07/21/2006
Last updated
08/09/2016
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