Healthcare Provider Details

I. General information

NPI: 1720181027
Provider Name (Legal Business Name): JEFFREY STOCKWELL WEBSTER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5901 E. 7 STREET VA MEDICAL CENTER (116B)
LONG BEACH CA
90822-5201
US

IV. Provider business mailing address

5901 E. 7TH STREET VA MEDICAL CENTER (116B)
LONG BEACH CA
90822
US

V. Phone/Fax

Practice location:
  • Phone: 562-826-8000
  • Fax: 562-826-5679
Mailing address:
  • Phone: 562-826-8000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY13555
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: