Provider Demographics
NPI:1295814150
Name:KNIPPA, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:KNIPPA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1650 XIMENO AVE
Mailing Address - Street 2:#230
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90804-2150
Mailing Address - Country:US
Mailing Address - Phone:562-494-3633
Mailing Address - Fax:
Practice Address - Street 1:1650 XIMENO AVE
Practice Address - Street 2:#230
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90804-2150
Practice Address - Country:US
Practice Address - Phone:562-494-3633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8833103TC0700X, 103G00000X
UT93-261633-2501103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist