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General NPI Number Information
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NPI Number | 1326103771
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Entity Type | Individual
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Provider Name | AMY J JAK PH.D.
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Gender | Female
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Dates
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Enumeration Date | 12/26/2006
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Last Update Date | 08/13/2007
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Provider Practice Location Address
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Address Line | UCSD NEUROPSYCHOLOGICAL ASSOCIATES 9500 GILMAN DR. (0603)
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City | LA JOLLA
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State | CA
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Zip | 92037-0603
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Country | US
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Telephone | 858-822-5791
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Fax |
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Provider Business Mailing Address
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Address Line | 3350 LA JOLLA VILLAGE DR 151B
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City | SAN DIEGO
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State | CA
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Zip | 92161-0002
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Country | US
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Telephone | 858-642-3742
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Fax | 858-642-1458
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 21113
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License Number State | CA
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