Provider Demographics
NPI:1477593416
Name:BRYSON, POLINA (PH D)
Entity Type:Individual
Prefix:MRS
First Name:POLINA
Middle Name:
Last Name:BRYSON
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:POLINA
Other - Middle Name:
Other - Last Name:RYZHIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609001
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92160-9001
Mailing Address - Country:US
Mailing Address - Phone:619-528-4600
Mailing Address - Fax:619-528-4625
Practice Address - Street 1:221 W CREST ST
Practice Address - Street 2:SUITE 102
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-1739
Practice Address - Country:US
Practice Address - Phone:760-489-4930
Practice Address - Fax:760-489-4933
Is Sole Proprietor?:No
Enumeration Date:2006-06-07
Last Update Date:2008-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20477103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWCP20477AMedicare PIN
CAW416Medicare PIN