MEDICARE: DR. JILL A STODDARD 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	PSY21852	CA

General Provider Information

NPI Number	:	1992974596
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JILL A STODDARD PH.D.

Provider Business Mailing Address
First Line	:	4627 OCEAN BLVD
Second Line	:	#413
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-2414
Country	:	US
Telephone Number	:	858-354-4077
Fax Number	:

Provider Business Practice Location Address
First Line	:	2801 CAMINO DEL RIO S
Second Line	:	SUITE 202
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3800
Country	:	US
Telephone Number	:	858-354-4077
Fax Number	:

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

Provider Enumeration Date	:	02/27/2008
Last Update Date	:	02/27/2008

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