Provider Demographics
NPI:1366510471
Name:POIZNER, JEFFREY M (PSYD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:M
Last Name:POIZNER
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:PO BOX 22051
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92192-2051
Mailing Address - Country:US
Mailing Address - Phone:858-822-2679
Mailing Address - Fax:
Practice Address - Street 1:190 GALBRAITH HL
Practice Address - Street 2:9500 GILMAN DRIVE #0304
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92093-0304
Practice Address - Country:US
Practice Address - Phone:858-822-2679
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-30
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 24960103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical