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NPI Code Detail

MEDICARE: MR. JEFFREY B HERSH PHD

MEDICARE: MR. JEFFREY B HERSH PHD
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
1103TC0700XClinical PsychologistPSY418540CA

General Provider Information

NPI Number : 1689614612
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JEFFREY B HERSH PHD
Provider Business Mailing Address
First Line : PO BOX 609001
Second Line :
City : SAN DIEGO
State : CA
Zip : 92160-9001
Country : US
Telephone Number : 619-528-4600
Fax Number : 619-528-4625
Provider Business Practice Location Address
First Line : 11770 BERNARDO PLAZA COURT
Second Line : SUITE 370
City : SAN DIEGO
State : CA
Zip : 92128-2426
Country : US
Telephone Number : 858-673-3360
Fax Number : 858-592-0884
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/07/2006
Last Update Date : 01/14/2008

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