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General NPI Number Information
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NPI Number | 1417261769
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Entity Type | Individual
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Provider Name | CINNAMON SUE BLOSS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 07/28/2010
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Last Update Date | 09/07/2010
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Provider Practice Location Address
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Address Line | 10666 N TORREY PINES RD
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City | LA JOLLA
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State | CA
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Zip | 92037-1027
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Country | US
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Telephone | 858-554-5737
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Fax | 858-546-9280
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Provider Business Mailing Address
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Address Line | FILE 54433
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City | LOS ANGELES
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State | CA
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Zip | 90074-4433
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Country | US
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Telephone |
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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 | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | PSY23085
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY23085
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License Number State | CA
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