Healthcare Provider Details

I. General information

NPI: 1871486969
Provider Name (Legal Business Name): KIRSTYN LEE PERRY PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2025
Last Update Date: 07/28/2026
Certification Date: 07/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3760 CONVOY ST STE 223
SAN DIEGO CA
92111-3744
US

IV. Provider business mailing address

3760 CONVOY ST STE 223
SAN DIEGO CA
92111-3744
US

V. Phone/Fax

Practice location:
  • Phone: 833-353-3213
  • Fax:
Mailing address:
  • Phone: 858-463-5917
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY36851
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: