Healthcare Provider Details

I. General information

NPI: 1477656700
Provider Name (Legal Business Name): JOSE ARMANDO JORGE PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/05/2006
Last Update Date: 05/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3702
US

IV. Provider business mailing address

680 LANGSDORF DR STE 200
FULLERTON CA
92831-3819
US

V. Phone/Fax

Practice location:
  • Phone: 714-871-9264
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY12951
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: