Healthcare Provider Details

I. General information

NPI: 1811198906
Provider Name (Legal Business Name): GEORGE JOSEPH GROSSO PHD PSYCH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/29/2007
Last Update Date: 03/14/2023
Certification Date: 03/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

24100 SORREL COURT
TEHACHAPI CA
93561
US

IV. Provider business mailing address

24100 SORREL COURT
TEHACHAPI CA
93561
US

V. Phone/Fax

Practice location:
  • Phone: 661-822-9011
  • Fax: 661-822-0476
Mailing address:
  • Phone: 661-822-9011
  • Fax: 661-822-0476

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY10108
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY10108
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code103TF0200X
TaxonomyForensic Psychologist
License NumberPSY10108
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: