Healthcare Provider Details

I. General information

NPI: 1255701348
Provider Name (Legal Business Name): JENNA SUWAY PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2015
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 SPORTFISHER DR
OCEANSIDE CA
92054-2550
US

IV. Provider business mailing address

1100 SPORTFISHER DR
OCEANSIDE CA
92054-2550
US

V. Phone/Fax

Practice location:
  • Phone: 760-439-6702
  • Fax: 760-439-4779
Mailing address:
  • Phone: 760-439-6702
  • Fax: 760-439-4779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: