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General NPI Number Information
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NPI Number | 1326506221
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Entity Type | Individual
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Provider Name | JESSE RYAN BASHEM PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2019
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Last Update Date | 07/07/2022
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Provider Practice Location Address
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Address Line | 4000 MACARTHUR BLVD STE 600
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City | NEWPORT BEACH
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State | CA
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Zip | 92660-2517
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Country | US
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Telephone | 949-899-2301
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 194
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City | MOORPARK
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State | CA
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Zip | 93020-0194
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Country | US
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Telephone | 949-899-2301
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY30607
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License Number State | CA
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