Provider Demographics
NPI:1598183956
Name:OVERHOLTZER, GYNA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GYNA
Middle Name:
Last Name:OVERHOLTZER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5005 TEXAS ST STE 302
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92108-3722
Mailing Address - Country:US
Mailing Address - Phone:619-361-1176
Mailing Address - Fax:
Practice Address - Street 1:5005 TEXAS ST STE 302
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-3722
Practice Address - Country:US
Practice Address - Phone:619-361-1176
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33649103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA92044495F74083OtherMEDI-CAL