MEDICARE: BIJOU GONZALEZ KOHNS 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	PSY35170	CA

General Provider Information

NPI Number	:	1750753448
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIJOU GONZALEZ KOHNS PH.D.

Provider Business Mailing Address
First Line	:	415 LAUREL ST # 3021
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1605
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	415 LAUREL ST # 3021
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92101-1605
Country	:	US
Telephone Number	:	999-999-9999
Fax Number	:

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

Provider Enumeration Date	:	10/21/2015
Last Update Date	:	02/04/2026

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