MEDICARE: GRICELDA FRAGOSO PSYD A PROFESSIONAL PSYCHOLOGY CORPORATION

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	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1669012787
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRICELDA FRAGOSO PSYD A PROFESSIONAL PSYCHOLOGY CORPORATION

Provider Business Mailing Address
First Line	:	1398 NIGHTSHADE RD
Second Line	:
City	:	CARLSBAD
State	:	CA
Zip	:	92011-3500
Country	:	US
Telephone Number	:	858-371-1865
Fax Number	:	760-557-2048

Provider Business Practice Location Address
First Line	:	721 N VULCAN AVE STE 209
Second Line	:
City	:	ENCINITAS
State	:	CA
Zip	:	92024-2191
Country	:	US
Telephone Number	:	604-878-4887
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL PSYCHOLOGIST/OWNER
Name	:	DR. GRICELDA FRAGOSO
Credential	:	PSYD
Telephone Number	:	760-487-8488

Provider Enumeration Date	:	01/07/2020
Last Update Date	:	02/16/2026

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