Individual
DR. JOSEPH PATRICK GANNON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
4445 EASTGATE MALL STE 200, SAN DIEGO, CA 92121-1979
(858) 705-5439
(858) 771-1078
Mailing address
4445 EASTGATE MALL STE 200, SAN DIEGO, CA 92121-1979
(858) 705-5439
(858) 771-1078
Taxonomy
Speciality
Code
Description
License number
State
103TB0200X
Cognitive & Behavioral Psychologist
Primary
PSY12034
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OPL120340
BLUE SHIELD/BLUE CROSS
CA
Enumeration date
10/13/2005
Last updated
08/28/2024
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