Provider Demographics
NPI:1043535487
Name:SMITH, PAMELA JEAN (CPT)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:SMITH
Suffix:
Gender:F
Credentials:CPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2548 PAULINE CT
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95348-3606
Mailing Address - Country:US
Mailing Address - Phone:209-722-4151
Mailing Address - Fax:209-722-4151
Practice Address - Street 1:2400 BATH ST
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4351
Practice Address - Country:US
Practice Address - Phone:805-569-7380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-29
Last Update Date:2010-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CACPT11261291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory