Healthcare Provider Details

I. General information

NPI: 1710823042
Provider Name (Legal Business Name): DEL MAR PSYCHOLOGY CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3525 DEL MAR HEIGHTS RD STE 115
SAN DIEGO CA
92130-2199
US

IV. Provider business mailing address

3525 DEL MAR HEIGHTS RD STE 115
SAN DIEGO CA
92130-2199
US

V. Phone/Fax

Practice location:
  • Phone: 619-500-2106
  • Fax:
Mailing address:
  • Phone: 619-500-2106
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. MARISSA ILENE GRAN
Title or Position: PSYCHOLOGIST
Credential: PH.D
Phone: 619-500-2106