Provider Demographics
NPI:1598943938
Name:TIMMIE POLLOCK, PH.D.
Entity Type:Organization
Organization Name:TIMMIE POLLOCK, PH.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TIMMIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:POLLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-452-5700
Mailing Address - Street 1:8950 VILLA LA JOLLA DR STE B204
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1705
Mailing Address - Country:US
Mailing Address - Phone:858-452-5700
Mailing Address - Fax:858-452-2012
Practice Address - Street 1:8950 VILLA LA JOLLA DR STE B204
Practice Address - Street 2:
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1705
Practice Address - Country:US
Practice Address - Phone:858-452-5700
Practice Address - Fax:858-452-2012
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-07
Last Update Date:2008-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9321103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP9321Medicare PIN