Provider Demographics
NPI:1598833501
Name:DOLZONEK, CYNTHIA M (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:DOLZONEK
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 1:4620 BERWICK DR
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-4230
Mailing Address - Country:US
Mailing Address - Phone:858-576-7233
Mailing Address - Fax:858-576-7245
Practice Address - Street 1:4834 DIANE AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92117-2911
Practice Address - Country:US
Practice Address - Phone:858-576-7233
Practice Address - Fax:858-576-7245
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9248103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY9248OtherPSYCHOLOGIST LICENSE
CAPW0092480Medicaid
CAPSY9248OtherPSYCHOLOGIST LICENSE