Provider Demographics
NPI:1982932182
Name:JAJODIA, ARCHANA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARCHANA
Middle Name:
Last Name:JAJODIA
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 1:13355 WINSTANLEY WAY
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-1403
Mailing Address - Country:US
Mailing Address - Phone:858-353-3345
Mailing Address - Fax:858-800-4803
Practice Address - Street 1:5230 CARROLL CANYON RD STE 316
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-1781
Practice Address - Country:US
Practice Address - Phone:858-353-3345
Practice Address - Fax:858-800-4803
Is Sole Proprietor?:No
Enumeration Date:2009-11-27
Last Update Date:2019-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TA0400X, 103TB0200X, 103TH0004X, 103TP2701X
CAPSY 23133103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
HF485AMedicare PIN