Provider Demographics
NPI:1932113370
Name:SALTZMAN, JODY (PHD)
Entity Type:Individual
Prefix:
First Name:JODY
Middle Name:
Last Name:SALTZMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12395 EL CAMINO REAL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-3085
Mailing Address - Country:US
Mailing Address - Phone:858-775-6364
Mailing Address - Fax:858-523-1037
Practice Address - Street 1:12395 EL CAMINO REAL
Practice Address - Street 2:SUITE 305
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-3085
Practice Address - Country:US
Practice Address - Phone:858-775-6364
Practice Address - Fax:858-523-1037
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-29
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14374103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY143740Medicaid
CASO5705Medicare UPIN
CACP14374Medicare ID - Type Unspecified