Healthcare Provider Details

I. General information

NPI: 1669012787
Provider Name (Legal Business Name): GRICELDA FRAGOSO PSYD A PROFESSIONAL PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/07/2020
Last Update Date: 02/16/2026
Certification Date: 02/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

721 N VULCAN AVE STE 209
ENCINITAS CA
92024-2191
US

IV. Provider business mailing address

1398 NIGHTSHADE RD
CARLSBAD CA
92011-3500
US

V. Phone/Fax

Practice location:
  • Phone: 604-878-4887
  • Fax:
Mailing address:
  • Phone: 858-371-1865
  • Fax: 760-557-2048

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. GRICELDA FRAGOSO
Title or Position: CLINICAL PSYCHOLOGIST/OWNER
Credential: PSYD
Phone: 760-487-8488