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Individual
DR. JESS H GHANNAM
Active
Individual
DR. JESS H GHANNAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
PSY9261
CA
103T00000X
Psychologist
PSY9261
CA
103TC0700X
Clinical Psychologist
Primary
PSY9261
CA
103TF0200X
Forensic Psychologist
PSY9261
CA
103TP2701X
Group Psychotherapy Psychologist
PSY9261
CA
103TR0400X
Rehabilitation Psychologist
PSY9261
CA
2084P2900X
Pain Medicine (Psychiatry & Neurology) Physician
PSY9261
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
ZZZ20562Z
GROUP ID NUMBER
CA
Enumeration date
12/28/2006
Last updated
09/05/2012
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