Provider Demographics
NPI:1902032220
Name:PIONEER PEDIATRICS INC
Entity Type:Organization
Organization Name:PIONEER PEDIATRICS INC
Other - Org Name:PIONEER PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:NANA
Authorized Official - Middle Name:KOBINA
Authorized Official - Last Name:KUFUOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-823-2118
Mailing Address - Street 1:PO BOX 371299
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89137
Mailing Address - Country:US
Mailing Address - Phone:702-869-6544
Mailing Address - Fax:702-541-7976
Practice Address - Street 1:4840 E. BONANZA ST
Practice Address - Street 2:SUITE 5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89110
Practice Address - Country:US
Practice Address - Phone:702-823-2118
Practice Address - Fax:702-823-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-01
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty