Healthcare Provider Details

I. General information

NPI: 1871871376
Provider Name (Legal Business Name): SUSAN M GEHRIG PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2011
Last Update Date: 09/12/2025
Certification Date: 09/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 HOTEL CIR N STE 450
SAN DIEGO CA
92108-2933
US

IV. Provider business mailing address

PO BOX 609001
SAN DIEGO CA
92160-9001
US

V. Phone/Fax

Practice location:
  • Phone: 619-692-1581
  • Fax: 619-692-1588
Mailing address:
  • Phone: 619-528-4600
  • Fax: 619-528-4625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number26228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: