MEDICARE: POLLYANNA V CASMAR PH.D.

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	103TC1900X	Counseling Psychologist

General Provider Information

NPI Number	:	1578599031
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	POLLYANNA V CASMAR PH.D.

Provider Business Mailing Address
First Line	:	VA SAN DIEGO HEALTHCARE SYSTEM
Second Line	:	3350 LA JOLLA VILLAGE DRIVE
City	:	SAN DIEGO
State	:	CA
Zip	:	92161-0001
Country	:	US
Telephone Number	:	858-552-8585
Fax Number	:	858-552-4315

Provider Business Practice Location Address
First Line	:	4452 PARK BLVD
Second Line	:	SUITE 310
City	:	SAN DIEGO
State	:	CA
Zip	:	92116-4051
Country	:	US
Telephone Number	:	619-297-0650
Fax Number	:	619-297-0650

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

Provider Enumeration Date	:	06/24/2006
Last Update Date	:	07/08/2007

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