Individual
IRA GROSSMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
4550 KEARNY VILLA ROAD, SUITE 214, SAN DIEGO, CA 92123-1563
(858) 560-0900
(858) 560-1266
Mailing address
4550 KEARNY VILLA ROAD, SUITE 214, SAN DIEGO, CA 92123-1563
(858) 560-0900
(858) 560-1266
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
PSY5618
CA
Other
Enumeration date
03/13/2007
Last updated
07/08/2007
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