Healthcare Provider Details

I. General information

NPI: 1124910179
Provider Name (Legal Business Name): PIONEER PEDIATRICS WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 W CHARLESTON BLVD STE 2
LAS VEGAS NV
89102-0080
US

IV. Provider business mailing address

3210 W CHARLESTON BLVD STE 2
LAS VEGAS NV
89102-0080
US

V. Phone/Fax

Practice location:
  • Phone: 702-370-7842
  • Fax:
Mailing address:
  • Phone: 702-370-7842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code2080P0008X
TaxonomyPediatric Neurodevelopmental Disabilities Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: PRISCILLA OTOO-ADJORLOLO
Title or Position: DIRECTOR
Credential: LCSW
Phone: 702-370-7842