MEDICARE: DR. JERI LYN MUSE PH.D., D.A.A.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TA0700X	Adult Development & Aging Psychologist
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TE1100X	Exercise & Sports Psychologist
4	103TH0100X	Health Service Psychologist
5	103T00000X	Psychologist	PSY17163	CA
6	103TP2701X	Group Psychotherapy Psychologist
7	103TR0400X	Rehabilitation Psychologist

General Provider Information

NPI Number	:	1295771251
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JERI LYN MUSE PH.D., D.A.A.P.M.

Provider Business Mailing Address
First Line	:	3033 FIFTH AVE
Second Line	:	SUITE 220
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5856
Country	:	US
Telephone Number	:	619-294-3466
Fax Number	:

Provider Business Practice Location Address
First Line	:	3033 FIFTH AVE
Second Line	:	SUITE 220
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5856
Country	:	US
Telephone Number	:	619-294-3466
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/20/2006
Last Update Date	:	09/21/2010

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