MEDICARE: GARY DEVOSS PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TB0200X	Cognitive & Behavioral Psychologist	PSY 8983	CA
2	103TC0700X	Clinical Psychologist	PSY 8983	CA
3	103TH0100X	Health Service Psychologist	PSY 8983	CA
4	103T00000X	Psychologist	PSY 8983	CA
5	103TP2701X	Group Psychotherapy Psychologist	PSY 8983	CA

General Provider Information

NPI Number	:	1558301549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GARY DEVOSS PH.D.

Provider Business Mailing Address
First Line	:	3405 KENYON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5003
Country	:	US
Telephone Number	:	619-523-9225
Fax Number	:	619-222-0230

Provider Business Practice Location Address
First Line	:	3405 KENYON ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92110-5003
Country	:	US
Telephone Number	:	619-523-9225
Fax Number	:	619-222-0230

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2006
Last Update Date	:	09/11/2025

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Directions to “ GARY DEVOSS PH.D.” Practice Location

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