Healthcare Provider Details

I. General information

NPI: 1225311806
Provider Name (Legal Business Name): MEGAN E GIETZEN PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 E PACIFIC COAST STE 320
LONG BEACH CA
90804-3271
US

IV. Provider business mailing address

1536 W 25TH ST
SAN PEDRO CA
90732-4415
US

V. Phone/Fax

Practice location:
  • Phone: 925-282-1778
  • Fax: 415-296-5299
Mailing address:
  • Phone: 562-549-1759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32415
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: