Provider Demographics
NPI:1760660252
Name:KROPP, JERRY (PSYD)
Entity Type:Individual
Prefix:
First Name:JERRY
Middle Name:
Last Name:KROPP
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:JEREMIAH
Other - Middle Name:
Other - Last Name:KROPP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:410 S MELROSE DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92081-6642
Mailing Address - Country:US
Mailing Address - Phone:760-298-0898
Mailing Address - Fax:760-806-4340
Practice Address - Street 1:410 S MELROSE DR
Practice Address - Street 2:SUITE 202
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92081-6642
Practice Address - Country:US
Practice Address - Phone:760-298-0898
Practice Address - Fax:760-806-4340
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23564103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical