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General NPI Number Information
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NPI Number | 1477093656
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Entity Type | Individual
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Provider Name | PRINCE POLLARD
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Gender | Male
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Dates
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Enumeration Date | 03/07/2017
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Last Update Date | 03/07/2017
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Provider Practice Location Address
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Address Line | 3365 WEST CRAIG ROAD SUITE 9
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City | LAS VEGAS
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State | NV
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Zip | 89031
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Country | US
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Telephone | 775-357-2623
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Fax |
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Provider Business Mailing Address
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Address Line | 1325 AIRMOTIVE WAY STE 205
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City | RENO
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State | NV
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Zip | 89502-3240
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Country | US
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Telephone | 928-529-8197
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 1404750365
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License Number State | NV
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