Provider Demographics
NPI:1275681645
Name:GRUNHAUS-BELZER, ROSA (PHD)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:
Last Name:GRUNHAUS-BELZER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4540 KEARNY VILLA RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-1571
Mailing Address - Country:US
Mailing Address - Phone:858-278-1089
Mailing Address - Fax:858-278-4972
Practice Address - Street 1:4540 KEARNY VILLA RD
Practice Address - Street 2:SUITE 215
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-1571
Practice Address - Country:US
Practice Address - Phone:858-278-1089
Practice Address - Fax:858-278-4972
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9082103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPU0090820Medicaid
CAW16053Medicare ID - Type Unspecified