MEDICARE: DR. CYNTHIA M. DOLZONEK PH.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	103TC0700X	Clinical Psychologist	PSY9248	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PSY9248	OTHER	CA	PSYCHOLOGIST LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1598833501
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CYNTHIA M. DOLZONEK PH.D.

Provider Business Mailing Address
First Line	:	4620 BERWICK DR
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-4230
Country	:	US
Telephone Number	:	858-576-7233
Fax Number	:	858-576-7245

Provider Business Practice Location Address
First Line	:	4834 DIANE AVE
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-2911
Country	:	US
Telephone Number	:	858-576-7233
Fax Number	:	858-576-7245

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

Provider Enumeration Date	:	11/30/2006
Last Update Date	:	07/08/2007

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