Provider Demographics
NPI:1821450669
Name:ENGUILLADO, POLLIE
Entity Type:Individual
Prefix:
First Name:POLLIE
Middle Name:
Last Name:ENGUILLADO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 SHORELINE CIR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-7036
Mailing Address - Country:US
Mailing Address - Phone:707-567-3584
Mailing Address - Fax:
Practice Address - Street 1:1214 SHORELINE CIR
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CA
Practice Address - Zip Code:94533-7036
Practice Address - Country:US
Practice Address - Phone:707-567-3584
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2016-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant