Healthcare Provider Details

I. General information

NPI: 1720045248
Provider Name (Legal Business Name): JOSETTE MARIE CIOLINO PSY. D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/27/2006
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 W 6TH ST # 459
SAN PEDRO CA
90731-3316
US

IV. Provider business mailing address

222 W 6TH ST STE 400
SAN PEDRO CA
90731-3345
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 310-971-1868
  • Fax: 310-707-2501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY18122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: