Provider Demographics
NPI:1487957551
Name:POLLARD, CARLOS RAMON
Entity type:Individual
Prefix:
First Name:CARLOS
Middle Name:RAMON
Last Name:POLLARD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5626 MAMMOUTH MOUNTAIN STREET
Mailing Address - Street 2:
Mailing Address - City:NORTH LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89108
Mailing Address - Country:US
Mailing Address - Phone:702-324-2126
Mailing Address - Fax:
Practice Address - Street 1:5626 MAMMOTH MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89081-2419
Practice Address - Country:US
Practice Address - Phone:702-324-2126
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-13
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1316279785Medicaid