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General NPI Number Information
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NPI Number | 1801462999
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Entity Type | Organization
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Legal Business Name | MINDWISE PSYCHOLOGICAL SERVICES, INC.
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Dates
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Enumeration Date | 05/31/2021
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Last Update Date | 05/31/2021
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Provider Practice Location Address
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Address Line | 3645 RUFFIN RD STE 300
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City | SAN DIEGO
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State | CA
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Zip | 92123-1845
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Country | US
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Telephone | 858-333-2027
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Fax |
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Provider Business Mailing Address
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Address Line | 3525 DEL MAR HEIGHTS RD # 1961
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City | SAN DIEGO
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State | CA
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Zip | 92130-2199
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Country | US
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Telephone | 858-333-2027
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | GOHAR GYURJYAN
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Credential |
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Telephone | 858-333-2027
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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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