Provider Demographics
NPI:1881867919
Name:POLLOCK, WILLIAM (PA-C)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:
Last Name:POLLOCK
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:MR
Other - First Name:BILL
Other - Middle Name:
Other - Last Name:POLLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA-C
Mailing Address - Street 1:2250 S MAIN ST
Mailing Address - Street 2:STE 104
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2538
Mailing Address - Country:US
Mailing Address - Phone:951-737-1454
Mailing Address - Fax:
Practice Address - Street 1:854 MAGNOLIA AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3109
Practice Address - Country:US
Practice Address - Phone:951-737-1454
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-09
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14751363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical