MEDICARE: DR. GRETCHEN ANN POUND

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	21504	CA

General Provider Information

NPI Number	:	1124229638
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRETCHEN ANN POUND

Provider Business Mailing Address
First Line	:	138 B AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92118-1511
Country	:	US
Telephone Number	:	858-663-7285
Fax Number	:

Provider Business Practice Location Address
First Line	:	138 B AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92118-1511
Country	:	US
Telephone Number	:	858-663-7285
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2007
Last Update Date	:	04/12/2008

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