Provider Demographics
NPI:1154793180
Name:JAHOLA, ANN
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:JAHOLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:792 AVOCADO AVE UNIT 15
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92020-6473
Mailing Address - Country:US
Mailing Address - Phone:619-396-8059
Mailing Address - Fax:
Practice Address - Street 1:792 AVOCADO AVE UNIT 15
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92020-6473
Practice Address - Country:US
Practice Address - Phone:619-396-8059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-29
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
3016923500OtherMEDI-CAL PROGRAM