Healthcare Provider Details

I. General information

NPI: 1740865013
Provider Name (Legal Business Name): POMILA INTEGRATED WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2021
Last Update Date: 02/08/2022
Certification Date: 01/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10800 CORKSCREW RD STE 210
ESTERO FL
33928-9453
US

IV. Provider business mailing address

10800 CORKSCREW RD STE 210
ESTERO FL
33928-9453
US

V. Phone/Fax

Practice location:
  • Phone: 844-290-7300
  • Fax: 844-787-9900
Mailing address:
  • Phone: 844-290-7300
  • Fax: 833-228-3600

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT POLLACK
Title or Position: OWNER
Credential: MD
Phone: 844-290-7300