Healthcare Provider Details

I. General information

NPI: 1710655931
Provider Name (Legal Business Name): GRANT EVAN GILBRETH ZOPPI MA, AMFT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2021
Last Update Date: 03/28/2023
Certification Date: 03/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7917 OSTROW ST STE A
SAN DIEGO CA
92111-3604
US

IV. Provider business mailing address

7917 OSTROW ST STE A
SAN DIEGO CA
92111-3604
US

V. Phone/Fax

Practice location:
  • Phone: 858-300-8282
  • Fax: 858-300-8284
Mailing address:
  • Phone: 858-300-8282
  • Fax: 858-300-8284

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: