Provider Demographics
NPI:1790819175
Name:POLLACK, RONALD DALE (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:DALE
Last Name:POLLACK
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 1:3585 MAPLE ST STE 205
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-9143
Mailing Address - Country:US
Mailing Address - Phone:805-676-1500
Mailing Address - Fax:805-644-2988
Practice Address - Street 1:3585 MAPLE ST STE 205
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-9143
Practice Address - Country:US
Practice Address - Phone:805-676-1500
Practice Address - Fax:805-644-2988
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG368502084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA91824Medicare UPIN