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General NPI Number Information
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NPI Number | 1669012787
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Entity Type | Organization
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Legal Business Name | GRICELDA FRAGOSO PSYD A PROFESSIONAL PSYCHOLOGY CORPORATION
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 01/30/2024
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Provider Practice Location Address
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Address Line | 721 N VULCAN AVE STE 209
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City | ENCINITAS
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State | CA
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Zip | 92024-2191
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Country | US
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Telephone | 604-878-4887
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Fax |
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Provider Business Mailing Address
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Address Line | 1398 NIGHTSHADE RD
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City | CARLSBAD
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State | CA
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Zip | 92011-3500
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Country | US
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Telephone | 858-371-1865
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Fax | 760-557-2048
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Authorized Official
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Title or Position | CLINICAL PSYCHOLOGIST/OWNER
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Name | DR. GRICELDA FRAGOSO
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Credential | PSYD
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Telephone | 760-487-8488
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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