Healthcare Provider Details

I. General information

NPI: 1124194915
Provider Name (Legal Business Name): JEFFREY R ZOOK PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9920 PACIFIC HEIGHTS BLVD STE 150
SAN DIEGO CA
92121-4361
US

IV. Provider business mailing address

735 VIA CAFETAL
SAN MARCOS CA
92069-7385
US

V. Phone/Fax

Practice location:
  • Phone: 619-403-9399
  • Fax:
Mailing address:
  • Phone: 619-403-9399
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY26522
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: