Healthcare Provider Details

I. General information

NPI: 1578599031
Provider Name (Legal Business Name): POLLYANNA V CASMAR PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/24/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 PARK BLVD SUITE 310
SAN DIEGO CA
92116-4051
US

IV. Provider business mailing address

VA SAN DIEGO HEALTHCARE SYSTEM 3350 LA JOLLA VILLAGE DRIVE
SAN DIEGO CA
92161-0001
US

V. Phone/Fax

Practice location:
  • Phone: 619-297-0650
  • Fax: 619-297-0650
Mailing address:
  • Phone: 858-552-8585
  • Fax: 858-552-4315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: