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General NPI Number Information
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NPI Number | 1881939387
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Entity Type | Individual
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Provider Name | DR. JAMIE ALLEN NODINE
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Gender | Male
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 12/02/2022
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Provider Practice Location Address
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Address Line | 10750 4TH ST
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-0979
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Country | US
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Telephone | 916-216-8130
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 51052
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City | IRVINE
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State | CA
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Zip | 92619-1052
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY27063
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License Number State | CA
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