Healthcare Provider Details

I. General information

NPI: 1205938420
Provider Name (Legal Business Name): STEPHEN H. GOULD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 06/21/2023
Certification Date: 06/21/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13755 PASEO BONITA
POWAY CA
92064-5867
US

IV. Provider business mailing address

13755 PASEO BONITA
POWAY CA
92064-5867
US

V. Phone/Fax

Practice location:
  • Phone: 619-871-8118
  • Fax:
Mailing address:
  • Phone: 619-871-8118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberG17215
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: