Provider Demographics
NPI:1336242809
Name:POCKROS, ANN WHEALEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANN
Middle Name:WHEALEN
Last Name:POCKROS
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:PO BOX 9905
Mailing Address - Street 2:
Mailing Address - City:RANCHO SANTA FE
Mailing Address - State:CA
Mailing Address - Zip Code:92067-4905
Mailing Address - Country:US
Mailing Address - Phone:858-552-1005
Mailing Address - Fax:858-756-5989
Practice Address - Street 1:4180 LA JOLLA VILLAGE DR
Practice Address - Street 2:SUITE 530
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1402
Practice Address - Country:US
Practice Address - Phone:858-552-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-07
Last Update Date:2009-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12732103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical