Provider Demographics
NPI:1124229638
Name:POUND, GRETCHEN ANN
Entity Type:Individual
Prefix:DR
First Name:GRETCHEN
Middle Name:ANN
Last Name:POUND
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 1:138 B AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92118-1511
Mailing Address - Country:US
Mailing Address - Phone:858-663-7285
Mailing Address - Fax:
Practice Address - Street 1:138 B AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92118-1511
Practice Address - Country:US
Practice Address - Phone:858-663-7285
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-31
Last Update Date:2008-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21504103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP21504Medicare PIN
CAWCP21504AMedicare PIN