MEDICARE: PIONEER PEDIATRICS WELLNESS CENTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2080P0008X	Pediatric Neurodevelopmental Disabilities Physician
2	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1851252886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PIONEER PEDIATRICS WELLNESS CENTER

Provider Business Mailing Address
First Line	:	4840 E BONANZA RD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3453
Country	:	US
Telephone Number	:	702-370-7842
Fax Number	:

Provider Business Practice Location Address
First Line	:	4840 E BONANZA RD STE 5
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89110-3453
Country	:	US
Telephone Number	:	702-370-7842
Fax Number	:

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	PRISCILLA VERNICE OTOO-ADJORLOLO
Credential	:
Telephone Number	:	702-370-7842

Provider Enumeration Date	:	11/19/2025
Last Update Date	:	11/19/2025

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