Healthcare Provider Details

I. General information

NPI: 1740766948
Provider Name (Legal Business Name): THERESA GISELL INCHAURREGUI PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/11/2018
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28328 AGOURA RD STE 102
AGOURA HILLS CA
91301-2739
US

IV. Provider business mailing address

28328 AGOURA RD STE 102
AGOURA HILLS CA
91301-2739
US

V. Phone/Fax

Practice location:
  • Phone: 818-900-5303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36587
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: