Healthcare Provider Details

I. General information

NPI: 1114676616
Provider Name (Legal Business Name): JULIA ROSENGREN PSYCHOLOGIST, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/22/2022
Last Update Date: 03/22/2022
Certification Date: 03/22/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5252 BALBOA AVE STE 803
SAN DIEGO CA
92117-6920
US

IV. Provider business mailing address

5252 BALBOA AVE STE 803
SAN DIEGO CA
92117-6920
US

V. Phone/Fax

Practice location:
  • Phone: 858-432-3919
  • Fax: 833-439-5561
Mailing address:
  • Phone: 858-432-3919
  • Fax: 833-439-5561

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. JULIA ROSENGREN
Title or Position: CEO
Credential: PSY.D.
Phone: 858-432-3919