Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PSY9321 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY9321 | CA |
NPI | 1003974361 |
---|---|
Provider Name | Timmie Pollock |
First Address | La Jolla, CA 92037-1705 |
Second Address | La Jolla, CA 92037-1714 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 05/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
330514125 | TAX ID (01) | CA |