Provider Demographics
NPI:1760691380
Name:JENNISON, JAMES H (PHD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:H
Last Name:JENNISON
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 1:116 N SANTA FE ST
Mailing Address - Street 2:
Mailing Address - City:HEMET
Mailing Address - State:CA
Mailing Address - Zip Code:92543-4426
Mailing Address - Country:US
Mailing Address - Phone:951-925-0115
Mailing Address - Fax:951-766-0975
Practice Address - Street 1:116 N SANTA FE ST
Practice Address - Street 2:
Practice Address - City:HEMET
Practice Address - State:CA
Practice Address - Zip Code:92543-4426
Practice Address - Country:US
Practice Address - Phone:951-925-0115
Practice Address - Fax:951-766-0975
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7586103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist