Healthcare Provider Details

I. General information

NPI: 1972412864
Provider Name (Legal Business Name): GAURAV MISHRA MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16868 VIA DEL CAMPO CT STE 100
SAN DIEGO CA
92127-1772
US

IV. Provider business mailing address

17159 W BERNARDO DR UNIT 202
SAN DIEGO CA
92127-1532
US

V. Phone/Fax

Practice location:
  • Phone: 313-629-9340
  • Fax:
Mailing address:
  • Phone: 313-629-9340
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. GAURAV MISHRA
Title or Position: PSYCHIATRIST/CEO
Credential: MD
Phone: 313-629-9340