| Gricelda Fragoso Psyd A Professional Psychology Corporation | |
|
721 N Vulcan Ave Ste 209 Encinitas CA 92024-2191 | |
| (604) 878-4887 | |
| Not Available |
| Full Name | Gricelda Fragoso Psyd A Professional Psychology Corporation |
|---|---|
| Speciality | Psychologist |
| Location | 721 N Vulcan Ave Ste 209, Encinitas, California |
| Authorized Official Name and Position | Gricelda Fragoso (CLINICAL PSYCHOLOGIST/OWNER) |
| Authorized Official Contact | 7604878488 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gricelda Fragoso Psyd A Professional Psychology Corporation 1398 Nightshade Rd Carlsbad CA 92011-3500 Ph: (858) 371-1865 | Gricelda Fragoso Psyd A Professional Psychology Corporation 721 N Vulcan Ave Ste 209 Encinitas CA 92024-2191 Ph: (604) 878-4887 |
| NPI Number | 1669012787 |
|---|---|
| Provider Enumeration Date | 01/07/2020 |
| Last Update Date | 01/30/2024 |
| Certification Date | 01/30/2024 |
| Medicare PECOS PAC ID | 8325463052 |
|---|---|
| Medicare Enrollment ID | O20200729000567 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669012787 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Gricelda Fragoso |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1689702540 PECOS PAC ID: 6507036530 Enrollment ID: I20200729000646 |
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