Provider Demographics
NPI:1629093356
Name:POLLAK, ERICH WALTER (MD)
Entity Type:Individual
Prefix:DR
First Name:ERICH
Middle Name:WALTER
Last Name:POLLAK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1038 S GLENDORA AVE
Mailing Address - Street 2:SUITE # 2
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790-4966
Mailing Address - Country:US
Mailing Address - Phone:626-814-2766
Mailing Address - Fax:626-917-3009
Practice Address - Street 1:1038 S GLENDORA AVE
Practice Address - Street 2:SUITE # 2
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-4966
Practice Address - Country:US
Practice Address - Phone:626-814-2766
Practice Address - Fax:626-917-3009
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA24059208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA01930 PPO 00A2459020OtherBLUE CROSS
CA00A24059Medicaid
CA00A24059Medicaid