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4652 Bannock Ave San Diego CA 92117-2922 | |
| (614) 323-2617 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Psychologist - Clinical |
| Location | 4652 Bannock Ave, San Diego, California |
| Authorized Official Name and Position | Lauren Gassier (OWNER) |
| Authorized Official Contact | 6143232617 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
4652 Bannock Ave San Diego CA 92117-2922 Ph: () - | 4652 Bannock Ave San Diego CA 92117-2922 Ph: (614) 323-2617 |
| NPI Number | 1700383825 |
|---|---|
| Provider Enumeration Date | 04/06/2018 |
| Last Update Date | 04/06/2018 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700383825 | NPI | - | NPPES |
| 1457760357 | Other | NPI | |
| 1255879722 | Other | NPI |
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