Healthcare Provider Details

I. General information

NPI: 1346353943
Provider Name (Legal Business Name): JEANNETTE J STOKOLS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 CORPORATE PARK SUITE 300
IRVINE CA
92606
US

IV. Provider business mailing address

8 CORPORATE PARK SUITE 300
IRVINE CA
92606
US

V. Phone/Fax

Practice location:
  • Phone: 949-857-5182
  • Fax: 949-786-8295
Mailing address:
  • Phone: 949-857-5182
  • Fax: 949-786-8295

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4932
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: