Healthcare Provider Details

I. General information

NPI: 1629538061
Provider Name (Legal Business Name): MS. ZHAO JIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CINDY JIA

II. Dates (important events)

Enumeration Date: 03/21/2019
Last Update Date: 09/19/2023
Certification Date: 09/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7050 PARKWAY DR
LA MESA CA
91942-1535
US

IV. Provider business mailing address

10717 CAMINO RUIZ STE 207
SAN DIEGO CA
92126-2364
US

V. Phone/Fax

Practice location:
  • Phone: 858-900-8946
  • Fax:
Mailing address:
  • Phone: 858-695-2211
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPCC14491
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: