Provider Demographics
NPI:1669015855
Name:TOMPKINS, JODI (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JODI
Middle Name:
Last Name:TOMPKINS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:836 PROSPECT ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-4213
Mailing Address - Country:US
Mailing Address - Phone:858-412-4626
Mailing Address - Fax:
Practice Address - Street 1:836 PROSPECT ST STE 101
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-4213
Practice Address - Country:US
Practice Address - Phone:858-412-4626
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-21
Last Update Date:2019-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY31106103T00000X
AZPSY005180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist