Healthcare Provider Details

I. General information

NPI: 1649482050
Provider Name (Legal Business Name): GLORIA VONHEBEL LYNCH PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 PEARL ST SUITE 1
LA JOLLA CA
92037-5134
US

IV. Provider business mailing address

1030 PEARL ST SUITE 1
LA JOLLA CA
92037-5134
US

V. Phone/Fax

Practice location:
  • Phone: 858-459-4291
  • Fax: 858-459-6548
Mailing address:
  • Phone: 858-459-4291
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY6726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: