Healthcare Provider Details

I. General information

NPI: 1235654930
Provider Name (Legal Business Name): GINA ANGEL POLLACK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: GINA POLLACK-MOXLEY

II. Dates (important events)

Enumeration Date: 08/03/2017
Last Update Date: 12/31/2025
Certification Date: 12/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR STE 312
LA MESA CA
91942-3050
US

IV. Provider business mailing address

823 GATEWAY CENTER WAY
SAN DIEGO CA
92102-4541
US

V. Phone/Fax

Practice location:
  • Phone: 619-515-2383
  • Fax:
Mailing address:
  • Phone: 619-515-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number107511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: