Provider Demographics
NPI:1093178261
Name:ABAO, PAMELA JOY RODRIGUEZ
Entity Type:Individual
Prefix:
First Name:PAMELA JOY
Middle Name:RODRIGUEZ
Last Name:ABAO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA JOY
Other - Middle Name:ROSAS
Other - Last Name:RODRIGUEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:140 SYLVESTER RD BLDG 500
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92106-3521
Mailing Address - Country:US
Mailing Address - Phone:619-553-0276
Mailing Address - Fax:
Practice Address - Street 1:140 SYLVESTER RD BLDG 500
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92106-3521
Practice Address - Country:US
Practice Address - Phone:619-553-0276
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-04
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA794784163WP0809X
CA95029526363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult