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General NPI Number Information
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NPI Number | 1922503739
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Entity Type | Individual
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Provider Name | DOUGLAS POLSTER PHD
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Gender | Male
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Dates
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Enumeration Date | 03/26/2018
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 300 STEIN PLAZA DRIVEWAY
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City | LOS ANGELES
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State | CA
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Zip | 90095-0001
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Country | US
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Telephone | 310-825-8944
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Fax |
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Provider Business Mailing Address
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Address Line | 10815 ROSE AVE APT 3
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City | LOS ANGELES
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State | CA
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Zip | 90034-5321
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Country | US
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Telephone | 908-642-6701
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103G00000X
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Taxonomy Name | Clinical Neuropsychologist
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License Number | 29235
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License Number State | CA
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