MEDICARE: DR. JONATHAN PAGE PH.D.

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	103T00000X	Psychologist	0005996	CO
2	103T00000X	Psychologist	PSY29526	CA
3	103T00000X	Psychologist	1166	NV

General Provider Information

NPI Number	:	1306222187
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN PAGE PH.D.

Provider Business Mailing Address
First Line	:	675 S GREEN VALLEY PKWY # 1310
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-0404
Country	:	US
Telephone Number	:	510-738-4078
Fax Number	:

Provider Business Practice Location Address
First Line	:	732 S 6TH ST STE N
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89101-6948
Country	:	US
Telephone Number	:	510-738-4078
Fax Number	:

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

Provider Enumeration Date	:	08/04/2015
Last Update Date	:	01/28/2025

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Directions to “ DR. JONATHAN PAGE PH.D.” Practice Location

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