Provider Demographics
NPI:1336458124
Name:CHIRCOP-ROLLICK, TATIANA ANASTASIA (PHD)
Entity Type:Individual
Prefix:DR
First Name:TATIANA
Middle Name:ANASTASIA
Last Name:CHIRCOP-ROLLICK
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:VA SAN DIEGO HEALTHCARE SYSTEM
Mailing Address - Street 2:3350 LA JOLLA VILLAGE DRIVE (116A)
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92161-0001
Mailing Address - Country:US
Mailing Address - Phone:858-552-8585
Mailing Address - Fax:
Practice Address - Street 1:VA SAN DIEGO HEALTHCARE SYSTEM
Practice Address - Street 2:3350 LA JOLLA VILLAGE DRIVE (116A)
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92161-0001
Practice Address - Country:US
Practice Address - Phone:858-552-8585
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23619103TC0700X, 286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical