Provider Demographics
NPI:1548460835
Name:GRAGOSSIAN, SEDA (PHD)
Entity type:Individual
Prefix:DR
First Name:SEDA
Middle Name:
Last Name:GRAGOSSIAN
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 1:5935 CORNERSTONE CT W
Mailing Address - Street 2:SUITE 125
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3737
Mailing Address - Country:US
Mailing Address - Phone:858-205-2490
Mailing Address - Fax:
Practice Address - Street 1:5935 CORNERSTONE CT W
Practice Address - Street 2:SUITE 125
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3737
Practice Address - Country:US
Practice Address - Phone:858-205-2490
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-24
Last Update Date:2016-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24901103TA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)