Jacob J Ambrose

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY34639 Issued in CA

Practice address

1110 24TH St
Apt 8
San Diego, CA 92102

Phone

(619) 728-4177

Fax

(573) 503-0122

NPI assigned

Oct 1, 2018

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Nov 15, 2023 through Nov 15, 2027

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Restore Psychology a Professional Corporation

  • Counseling Psychologist
  • San Diego, CA
  • NPI 1154176295
  NPD Authorized official
• Hillcrest Psychological Associates, PC

  • Psychologist
  • San Diego, CA
  • NPI 1073047239
  NPD (past)
• Hillcrest Psychological Associates, PC

  • Psychologist
  • San Diego, CA
  • NPI 1124425087
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1538352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734912000000",
    "number": "1588149017",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1110 24TH STREET",
            "address_2": "APT 8",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921022000",
            "telephone_number": "619-728-4177",
            "fax_number": "573-503-0122"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1110 24TH ST",
            "address_2": "APT 8",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "92102",
            "telephone_number": "619-728-4177",
            "fax_number": "573-503-0122"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMBROSE",
        "first_name": "JACOB",
        "middle_name": "J",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-10-01",
        "last_updated": "2024-12-23",
        "certification_date": "2024-12-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY34639",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nicolette Ambriz
• Yesenia Ambriz
• Elizabeth Lauren Ambros, RN
• Ambrose Health P C
• Gregory Ambrose, PHARM D
• Joseph M Ambrose, O.D.
• Marie Frances Ambrose, MS, RD
• Nicole Ambrose, PA-C
• Tilbe Ambrose, PHD
• Cameron Ambrosini

• Clinical Psychologist in San Diego, CA
• Providers in San Diego, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 23, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.