Provider Demographics
NPI:1003418195
Name:POLLARD, ISIS MARIE
Entity Type:Individual
Prefix:
First Name:ISIS
Middle Name:MARIE
Last Name:POLLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35655 PEPPERMINT PL
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-4492
Mailing Address - Country:US
Mailing Address - Phone:951-775-7138
Mailing Address - Fax:
Practice Address - Street 1:12235 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:CA
Practice Address - Zip Code:90680-3939
Practice Address - Country:US
Practice Address - Phone:714-293-2792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician