Ito, Jack Warren

Ito, Jack Warren is an individual health care provider with primary practice located at Naval Hospital 29 Palms Mcagcc, 29 Palms CA 92278. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Ito, Jack Warren can be contacted via phone (760) 830-2782.

Contact Information

Primary practice address
Naval Hospital 29 Palms Mcagcc 29 Palms CA 92278
Phone: (760) 830-2782
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Clinical 103TC0700X PS008530L Pennsylvania
Behavioral Health & Social Service Providers / Psychologist 103T00000X PS008530L Pennsylvania

Profile Details

NPI number 1710966593
LBN Legal business name Ito, Jack Warren
Credentials PHD
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 11th, 2006
Last updated Nov 1st, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1710966593 NPPES
Pennsylvania MEDICAID 016536380004
Pennsylvania Other 163751
Pennsylvania Other 959098
Pennsylvania Other A771081

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