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General NPI Number Information
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NPI Number | 1558061960
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Entity Type | Individual
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Provider Name | JORDAN THOMAS STIVER PHD
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Gender | Male
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Dates
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Enumeration Date | 03/06/2023
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Last Update Date | 11/14/2025
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Provider Practice Location Address
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Address Line | 9444 MEDICAL CENTER DR
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City | LA JOLLA
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State | CA
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Zip | 92037-1337
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Country | US
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Telephone | 858-657-8540
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 860912
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City | MINNEAPOLIS
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State | MN
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Zip | 55486-0912
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Country | US
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Telephone | 480-301-8000
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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 | PSY-005967
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License Number State | AZ
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