MEDICARE: DR. CINDY BOLLMAN 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	PSY16111	CA

General Provider Information

NPI Number	:	1962709030
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CINDY BOLLMAN PH.D.

Provider Business Mailing Address
First Line	:	6209 SAN JOAQUIN PLZ
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5983
Country	:	US
Telephone Number	:	949-520-7958
Fax Number	:

Provider Business Practice Location Address
First Line	:	6209 SAN JOAQUIN PLZ
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-5983
Country	:	US
Telephone Number	:	949-520-7958
Fax Number	:

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

Provider Enumeration Date	:	02/25/2011
Last Update Date	:	09/24/2020

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