MEDICARE: MISS KATHRYN MARIE POLLOCK R.D., C.D.

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
1	133V00000X	Registered Dietitian	933877	WI

General Provider Information

NPI Number	:	1558671479
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS KATHRYN MARIE POLLOCK R.D., C.D.

Provider Business Mailing Address
First Line	:	1820 S EL CAMINO REAL
Second Line	:	A107
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4917
Country	:	US
Telephone Number	:	262-853-7784
Fax Number	:

Provider Business Practice Location Address
First Line	:	1820 S EL CAMINO REAL
Second Line	:	A107
City	:	ENCINITAS
State	:	CA
Zip	:	92024-4917
Country	:	US
Telephone Number	:	262-853-7784
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/13/2010
Last Update Date	:	10/13/2010

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