Basic Information
| Provider Information | |||||||||
| NPI: | 1952312993 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POLLOCK | ||||||||
| FirstName: | MARC | ||||||||
| MiddleName: | E. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | P.O. BOX 10970 | ||||||||
| Address2: | |||||||||
| City: | WESTMINSTER | ||||||||
| State: | CA | ||||||||
| PostalCode: | 926850970 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 350 SOUTH OAK AVENUE | ||||||||
| Address2: | |||||||||
| City: | OAKDALE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 953613519 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2098473011 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/11/2006 | ||||||||
| LastUpdateDate: | 12/09/2008 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146D00000X | G51983 | CA | Y | Emergency Medical Service Providers | Personal Emergency Response Attendant | 207P00000X | G51983 | CA | N | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00G519830 | 05 | CA | MEDICAID |