MEDICARE: DR. DAVID S. GRUDER PH.D.

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	PSY9266	CA
2	106H00000X	Marriage & Family Therapist	MFT18889	CA

General Provider Information

NPI Number	:	1558405936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DAVID S. GRUDER PH.D.

Provider Business Mailing Address
First Line	:	1155 CAMINO DEL MAR # 516
Second Line	:
City	:	DEL MAR
State	:	CA
Zip	:	92014-2605
Country	:	US
Telephone Number	:	858-755-1988
Fax Number	:	858-876-3044

Provider Business Practice Location Address
First Line	:	3365 2ND AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-5611
Country	:	US
Telephone Number	:	858-755-1988
Fax Number	:	858-876-3044

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/17/2007
Last Update Date	:	09/11/2025

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