Healthcare Provider Details

I. General information

NPI: 1750418042
Provider Name (Legal Business Name): SONIA ANGELICA BAHRO PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

480 ALTA RD
SAN DIEGO CA
92179-0001
US

IV. Provider business mailing address

480 ALTA RD
SAN DIEGO CA
92179-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-370-2917
  • Fax:
Mailing address:
  • Phone: 619-370-2917
  • Fax: 619-671-6538

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY22039
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: