Provider Demographics
NPI:1144427204
Name:JOSEBACHVILI, JONATHAN H (MFT)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:H
Last Name:JOSEBACHVILI
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4660 PALM AVE
Mailing Address - Street 2:KAISER PERMANENTE - DEPARTMENT OF PSYCHIATRY
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92154-8404
Mailing Address - Country:US
Mailing Address - Phone:619-662-5000
Mailing Address - Fax:619-662-5375
Practice Address - Street 1:4660 PALM AVE
Practice Address - Street 2:KAISER PERMANENTE - DEPARTMENT OF PSYCHIATRY
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92154-8404
Practice Address - Country:US
Practice Address - Phone:619-662-5000
Practice Address - Fax:619-662-5375
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF47598106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist