Provider Demographics
NPI:1962106617
Name:BOZHKO, TETIANA
Entity type:Individual
Prefix:
First Name:TETIANA
Middle Name:
Last Name:BOZHKO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:132 BELWOOD LN UNIT A
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-5142
Mailing Address - Country:US
Mailing Address - Phone:341-758-0346
Mailing Address - Fax:
Practice Address - Street 1:132 BELWOOD LN UNIT A
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-5142
Practice Address - Country:US
Practice Address - Phone:341-758-0346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician