Healthcare Provider Details

I. General information

NPI: 1497048490
Provider Name (Legal Business Name): JAMIE ANN CISAR PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2011
Last Update Date: 10/28/2021
Certification Date: 10/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 TOYON AVENUE SUITE F #136
SAN JOSE CA
95127
US

IV. Provider business mailing address

302 TOYON AVENUE SUITE F #136
SAN JOSE CA
95127
US

V. Phone/Fax

Practice location:
  • Phone: 408-649-4522
  • Fax:
Mailing address:
  • Phone: 408-649-4522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY32840
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: