Provider Demographics
NPI:1932758638
Name:GRIFFITHS, JO ANNA B
Entity Type:Individual
Prefix:
First Name:JO ANNA
Middle Name:B
Last Name:GRIFFITHS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JUNE
Other - Middle Name:R
Other - Last Name:GRIFFITHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1640 BROADWAY APT 22
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92101-5722
Mailing Address - Country:US
Mailing Address - Phone:619-802-5263
Mailing Address - Fax:
Practice Address - Street 1:11650 IBERIA PL STE 130
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2431
Practice Address - Country:US
Practice Address - Phone:858-264-5858
Practice Address - Fax:858-649-6012
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician