Provider Demographics
NPI:1831728112
Name:HINZE, JASON HEATH (PSYD)
Entity type:Individual
Prefix:DR
First Name:JASON
Middle Name:HEATH
Last Name:HINZE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:724 CORPORATE CENTER DR FL 2
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91768-2655
Mailing Address - Country:US
Mailing Address - Phone:909-622-6222
Mailing Address - Fax:
Practice Address - Street 1:724 CORPORATE CENTER DR FL 2
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91768-2655
Practice Address - Country:US
Practice Address - Phone:909-622-6222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-07
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23840103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical