Provider Demographics
NPI:1720240245
Name:NACHISON, JON (PHD, ABPP)
Entity Type:Individual
Prefix:DR
First Name:JON
Middle Name:
Last Name:NACHISON
Suffix:
Gender:M
Credentials:PHD, ABPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 CAMINO DEL RIO N
Mailing Address - Street 2:SUITE 211
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1621
Mailing Address - Country:US
Mailing Address - Phone:619-291-0773
Mailing Address - Fax:
Practice Address - Street 1:2650 CAMINO DEL RIO N
Practice Address - Street 2:SUITE 211
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1621
Practice Address - Country:US
Practice Address - Phone:619-291-0773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-26
Last Update Date:2008-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical