MEDICARE: PSYCHPRO CONSULTING, PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1245045194
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PSYCHPRO CONSULTING, PC

Provider Business Mailing Address
First Line	:	3110 CAMINO DEL RIO S STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3831
Country	:	US
Telephone Number	:	619-693-8327
Fax Number	:

Provider Business Practice Location Address
First Line	:	3110 CAMINO DEL RIO S STE 220
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92108-3831
Country	:	US
Telephone Number	:	619-693-8327
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. PIA KHANDEKAR
Credential	:	PSYD
Telephone Number	:	619-693-8327

Provider Enumeration Date	:	02/10/2025
Last Update Date	:	02/10/2025

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