Healthcare Provider Details

I. General information

NPI: 1154066496
Provider Name (Legal Business Name): BEN WRIGHT GIBBINS PSY.D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2022
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 ALTA RD
SAN DIEGO CA
92179-0001
US

IV. Provider business mailing address

1724 METRO AVE APT 5111
CHULA VISTA CA
91915-3224
US

V. Phone/Fax

Practice location:
  • Phone: 619-661-6500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY36346
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: