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General NPI Number Information
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NPI Number | 1124910179
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Entity Type | Organization
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Legal Business Name | PIONEER PEDIATRICS WELLNESS CENTER
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 11/30/2025
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Provider Practice Location Address
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Address Line | 3210 W CHARLESTON BLVD STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89102-0080
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Country | US
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Telephone | 702-370-7842
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Fax |
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Provider Business Mailing Address
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Address Line | 3210 W CHARLESTON BLVD STE 2
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City | LAS VEGAS
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State | NV
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Zip | 89102-0080
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Country | US
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Telephone | 702-370-7842
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Fax |
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Authorized Official
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Title or Position | DIRECTOR
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Name | PRISCILLA OTOO-ADJORLOLO
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Credential | LCSW
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Telephone | 702-370-7842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 2080P0008X
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Taxonomy Name | Pediatric Neurodevelopmental Disabilities Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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