Healthcare Provider Details

I. General information

NPI: 1063762656
Provider Name (Legal Business Name): JODI PINN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/11/2012
Last Update Date: 09/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E HAMILTON AVE SUITE 100
CAMPBELL CA
95008-0664
US

IV. Provider business mailing address

900 E HAMILTON AVE SUITE 100
CAMPBELL CA
95008-0664
US

V. Phone/Fax

Practice location:
  • Phone: 877-454-6469
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY19171
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: