MEDICARE: DR. JAYSON L. MYSTKOWSKI PH.D.

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	103TC0700X	Clinical Psychologist	PSY20077	CA

General Provider Information

NPI Number	:	1821024845
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAYSON L. MYSTKOWSKI PH.D.

Provider Business Mailing Address
First Line	:	5757 WILSHIRE BLVD STE 439
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3628
Country	:	US
Telephone Number	:	310-579-9335
Fax Number	:	310-579-9335

Provider Business Practice Location Address
First Line	:	5757 WILSHIRE BLVD STE 439
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3628
Country	:	US
Telephone Number	:	310-579-9335
Fax Number	:	310-579-9335

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

Provider Enumeration Date	:	06/23/2006
Last Update Date	:	08/31/2021

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