Provider Demographics
NPI:1467132258
Name:GRUBSCHMIDT, AVA CECELIA
Entity Type:Individual
Prefix:
First Name:AVA
Middle Name:CECELIA
Last Name:GRUBSCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 CAMINO DEL RIO N STE 105
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-1747
Mailing Address - Country:US
Mailing Address - Phone:619-507-9333
Mailing Address - Fax:619-467-4595
Practice Address - Street 1:3570 CAMINO DEL RIO N STE 105
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-1747
Practice Address - Country:US
Practice Address - Phone:619-507-9333
Practice Address - Fax:619-467-4595
Is Sole Proprietor?:No
Enumeration Date:2023-07-18
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health