Provider Demographics
NPI:1588694954
Name:JENKINS HALL, CATHEARINE (PHD)
Entity type:Individual
Prefix:
First Name:CATHEARINE
Middle Name:
Last Name:JENKINS HALL
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 1:27281 LAS RAMBLAS
Mailing Address - Street 2:STE. 130
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6324
Mailing Address - Country:US
Mailing Address - Phone:949-367-1335
Mailing Address - Fax:949-305-3380
Practice Address - Street 1:27281 LAS RAMBLAS
Practice Address - Street 2:STE. 130
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6324
Practice Address - Country:US
Practice Address - Phone:949-367-1335
Practice Address - Fax:949-305-3380
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2015-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8239103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP8239Medicare UPIN