Healthcare Provider Details

I. General information

NPI: 1225748627
Provider Name (Legal Business Name): CYNTHIA JONES LEVIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/28/2022
Last Update Date: 11/28/2022
Certification Date: 11/28/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7590 FAY AVE
LA JOLLA CA
92037-4885
US

IV. Provider business mailing address

1949 CAMINITO EL CANARIO
LA JOLLA CA
92037-5712
US

V. Phone/Fax

Practice location:
  • Phone: 858-263-4226
  • Fax: 858-263-4206
Mailing address:
  • Phone: 619-890-6394
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number16242
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: