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General NPI Number Information
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NPI Number | 1720162944
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Entity Type | Individual
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Provider Name | JONATHAN D CANICK PHD
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Gender | Male
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Dates
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Enumeration Date | 10/24/2006
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 2100 WEBSTER ST SUITE 320
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-2377
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Country | US
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Telephone | 415-600-1491
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Fax | 415-474-9423
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Provider Business Mailing Address
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Address Line | 2100 WEBSTER STREET SUITE 320
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City | SAN FRANCISCO
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State | CA
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Zip | 94115-2377
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Country | US
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Telephone | 415-600-1491
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Fax | 415-474-9423
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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 | PSY11376
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License Number State | CA
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