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General NPI Number Information
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NPI Number | 1245115724
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Entity Type | Organization
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Legal Business Name | F.I.R.E. IGNITING LIVES PSYCHOLOGY
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Dates
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Enumeration Date | 08/06/2025
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Last Update Date | 08/06/2025
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Provider Practice Location Address
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Address Line | 500 LA TERRAZA BLVD STE 150
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City | ESCONDIDO
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State | CA
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Zip | 92025-3876
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Country | US
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Telephone | 760-478-6863
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Fax |
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Provider Business Mailing Address
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Address Line | 10531 4S COMMONS DR # 126
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City | SAN DIEGO
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State | CA
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Zip | 92127-3517
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT/OWNER
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Name | DR. GIMEL ROGERS
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Credential | PSYD, ABPP
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Telephone | 760-478-6863
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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