Healthcare Provider Details

I. General information

NPI: 1700172913
Provider Name (Legal Business Name): JAMES A POLLACK MD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2011
Last Update Date: 06/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1594 S IMPERIAL AVE
EL CENTRO CA
92243-4241
US

IV. Provider business mailing address

1594 S IMPERIAL AVE
EL CENTRO CA
92243-4241
US

V. Phone/Fax

Practice location:
  • Phone: 760-337-1025
  • Fax: 760-337-1011
Mailing address:
  • Phone: 760-337-1025
  • Fax: 760-337-1011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberG88748
License Number StateCA

VIII. Authorized Official

Name: JAMES A POLLACK
Title or Position: CEO
Credential: MD
Phone: 760-337-1025