Provider Demographics
NPI:1649398124
Name:POLKINHORN, HARRY (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:
Last Name:POLKINHORN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:HARRY
Other - Middle Name:
Other - Last Name:POLKINHORN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:P.O. BOX 22268
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92122
Mailing Address - Country:US
Mailing Address - Phone:858-395-4440
Mailing Address - Fax:858-587-0960
Practice Address - Street 1:3232 GOVERNOR DR
Practice Address - Street 2:SUITE J
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92122-2931
Practice Address - Country:US
Practice Address - Phone:858-395-4440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 40094106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist