Healthcare Provider Details

I. General information

NPI: 1699342436
Provider Name (Legal Business Name): JIGSAW DIAGNOSTICS, A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2021
Last Update Date: 06/09/2021
Certification Date: 06/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 ASHTON AVE
MENLO PARK CA
94025-6501
US

IV. Provider business mailing address

2131 ASHTON AVE
MENLO PARK CA
94025-6501
US

V. Phone/Fax

Practice location:
  • Phone: 571-213-7572
  • Fax:
Mailing address:
  • Phone: 571-213-7572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MR. JUSTIN HO
Title or Position: TREASURER
Credential:
Phone: 571-213-7572