Jack Warren Ito, PHD

NPI #1710966593 in 29 Palms, California

Provider Information

NPI Number: 1710966593
Entity Type: Individual
Name: Jack Warren Ito, PHD
Gender: Not Specified
Sole Proprietor: No
Primary Specialty: Psychologist - Clinical
Credential: PHD
Enumeration Date: Jan 11, 2006
Last Updated: Nov 1, 2007

Practice Location

Address: NAVAL HOSPITAL 29 PALMS
Address 2: MCAGCC
City: 29 Palms
State: California
ZIP Code: 92278
Phone: (760) 830-2782

Specialties & Taxonomy Codes

Specialty	Taxonomy Code	Primary
Psychologist - Clinical — Clinical	103TC0700X	Primary
Psychologist	103T00000X

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