Healthcare Provider Details

I. General information

NPI: 1154078962
Provider Name (Legal Business Name): JEFFREY P. BJORCK PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/02/2022
Last Update Date: 03/02/2022
Certification Date: 03/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 N OAKLAND AVE
PASADENA CA
91101-1714
US

IV. Provider business mailing address

330 GRAND AVE
MONROVIA CA
91016-2332
US

V. Phone/Fax

Practice location:
  • Phone: 626-584-5530
  • Fax:
Mailing address:
  • Phone: 626-359-7282
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY13408
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: