Healthcare Provider Details

I. General information

NPI: 1598991465
Provider Name (Legal Business Name): JODENA OPHEIM PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2009
Last Update Date: 11/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23370 ROAD 22
CHOWCHILLA CA
93610-8504
US

IV. Provider business mailing address

23370 ROAD 22
CHOWCHILLA CA
93610-8504
US

V. Phone/Fax

Practice location:
  • Phone: 559-665-5531
  • Fax:
Mailing address:
  • Phone: 559-665-5531
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY22625
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: