Provider Demographics
NPI:1871765818
Name:POLLARD-GENSBERG, ELISABETH G (OTR/L)
Entity type:Individual
Prefix:
First Name:ELISABETH
Middle Name:G
Last Name:POLLARD-GENSBERG
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 CIELO VISTA TER
Mailing Address - Street 2:
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-6006
Mailing Address - Country:US
Mailing Address - Phone:831-601-3841
Mailing Address - Fax:
Practice Address - Street 1:200 CAMINO AGUAJITO STE 205
Practice Address - Street 2:
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-3372
Practice Address - Country:US
Practice Address - Phone:831-601-3841
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOT60003479174400000X
CAOT10225174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist