Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | 24901 | CA |
NPI | 1548460835 |
---|---|
Provider Name | Dr. Seda Gragossian |
First Address | San Diego, CA 92121-3737 |
Second Address | San Diego, CA 92121-3737 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2007 |
Last Update Date | 14/10/2016 |