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General NPI Number Information
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NPI Number | 1508878331
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Entity Type | Individual
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Provider Name | GEORGETTE GAVIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 08/12/2006
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Last Update Date | 02/28/2023
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Provider Practice Location Address
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Address Line | 2344 FIRE MOUNTAIN DR
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City | OCEANSIDE
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State | CA
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Zip | 92054-6117
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Country | US
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Telephone | 760-420-1500
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Fax | 760-721-3637
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Provider Business Mailing Address
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Address Line | 2344 FIRE MOUNTAIN DR
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City | OCEANSIDE
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State | CA
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Zip | 92054-6117
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Country | US
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Telephone | 760-721-3637
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Fax | 760-721-3764
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY 17330
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License Number State | CA
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