Healthcare Provider Details

I. General information

NPI: 1144899006
Provider Name (Legal Business Name): POLLY LYNNDOWNEY COUNTS PPSE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/23/2021
Last Update Date: 06/23/2021
Certification Date: 06/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1706 SERRANO ST
OCEANSIDE CA
92054-6042
US

IV. Provider business mailing address

1706 SERRANO ST
OCEANSIDE CA
92054-6042
US

V. Phone/Fax

Practice location:
  • Phone: 760-473-8470
  • Fax:
Mailing address:
  • Phone: 760-473-8470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberPPSE
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: