Provider Demographics
NPI:1720022825
Name:POLLAK, RICHARD GEORGE (MD)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:GEORGE
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 1:47 SANTA ROSA ST
Mailing Address - Street 2:SUITE 900
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-5816
Mailing Address - Country:US
Mailing Address - Phone:805-542-9596
Mailing Address - Fax:805-542-9354
Practice Address - Street 1:1911 JOHNSON AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4131
Practice Address - Country:US
Practice Address - Phone:805-543-5353
Practice Address - Fax:805-595-2382
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2016-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG37625207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47168Medicare UPIN