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NPI Code Detail

MEDICARE: KENDRA MIEKO POLLOCK

MEDICARE: KENDRA MIEKO POLLOCK
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TS0200XSchool Psychologist4063CA

General Provider Information

NPI Number : 1457146979
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRA MIEKO POLLOCK
Provider Business Mailing Address
First Line : 369B 3RD ST # 549
Second Line :
City : SAN RAFAEL
State : CA
Zip : 94901-3581
Country : US
Telephone Number : 415-870-3922
Fax Number :
Provider Business Practice Location Address
First Line : 2501 CHESTNUT ST
Second Line :
City : OAKLAND
State : CA
Zip : 94607-2477
Country : US
Telephone Number : 510-452-2063
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/14/2025
Last Update Date : 04/14/2025

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Directions to “ KENDRA MIEKO POLLOCK ” Practice Location

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