Provider Demographics
NPI:1851252886
Name:PIONEER PEDIATRICS WELLNESS CENTER
Entity type:Organization
Organization Name:PIONEER PEDIATRICS WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PRISCILLA
Authorized Official - Middle Name:VERNICE
Authorized Official - Last Name:OTOO-ADJORLOLO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-370-7842
Mailing Address - Street 1:4840 E BONANZA RD STE 5
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89110-3453
Mailing Address - Country:US
Mailing Address - Phone:702-370-7842
Mailing Address - Fax:
Practice Address - Street 1:4840 E BONANZA RD STE 5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110-3453
Practice Address - Country:US
Practice Address - Phone:702-370-7842
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-11-19
Last Update Date:2025-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No2080P0008XAllopathic & Osteopathic PhysiciansPediatricsNeurodevelopmental DisabilitiesGroup - Multi-Specialty