Provider Demographics
NPI:1558405936
Name:GRUDER, DAVID S (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:S
Last Name:GRUDER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1155 CAMINO DEL MAR # 516
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-2605
Mailing Address - Country:US
Mailing Address - Phone:858-755-1988
Mailing Address - Fax:858-876-3044
Practice Address - Street 1:3365 2ND AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-5611
Practice Address - Country:US
Practice Address - Phone:858-755-1988
Practice Address - Fax:858-876-3044
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9266103TC0700X
CAMFT18889106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist