Healthcare Provider Details

I. General information

NPI: 1396470779
Provider Name (Legal Business Name): CHRISTOPHER RYAN POLLOCK
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/20/2022
Last Update Date: 06/19/2025
Certification Date: 06/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 VIA MINDI
RIVERSIDE CA
92506-3641
US

IV. Provider business mailing address

3286 E GUASTI RD STE 100
ONTARIO CA
91761-8646
US

V. Phone/Fax

Practice location:
  • Phone: 424-330-8400
  • Fax:
Mailing address:
  • Phone: 909-476-2023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT154067
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: