Healthcare Provider Details

I. General information

NPI: 1134524093
Provider Name (Legal Business Name): ALLISON RENEE KAUP PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15611 POMERADO RD STE 580
POWAY CA
92064-2438
US

IV. Provider business mailing address

6010 HIDDEN VALLEY RD STE 200
CARLSBAD CA
92011-4219
US

V. Phone/Fax

Practice location:
  • Phone: 760-631-3000
  • Fax: 760-270-9534
Mailing address:
  • Phone: 760-631-3000
  • Fax: 760-270-9534

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY26484
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26484
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: