Healthcare Provider Details

I. General information

NPI: 1205935962
Provider Name (Legal Business Name): MELODY DAWN POKORNY IMF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3142 VISTA WAY SUITE 205
OCEANSIDE CA
92056-3619
US

IV. Provider business mailing address

844 GLENWOOD DR
OCEANSIDE CA
92057-6348
US

V. Phone/Fax

Practice location:
  • Phone: 760-758-1480
  • Fax: 760-435-9472
Mailing address:
  • Phone: 760-726-6519
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF 43678
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: