Provider Demographics
NPI:1801802558
Name:JUNG, REX (PHD)
Entity type:Individual
Prefix:
First Name:REX
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1300 CENTRAL AVE SW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87102-2805
Mailing Address - Country:US
Mailing Address - Phone:505-243-0335
Mailing Address - Fax:505-216-2623
Practice Address - Street 1:1300 CENTRAL AVE SW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87102-2805
Practice Address - Country:US
Practice Address - Phone:505-243-0335
Practice Address - Fax:505-216-2623
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-09-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM0880103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist