Provider Demographics
NPI:1265509574
Name:PAMMENTER, ARTHUR (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
Last Name:PAMMENTER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9815 CARROLL CANYON RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92131-1123
Mailing Address - Country:US
Mailing Address - Phone:858-831-0795
Mailing Address - Fax:858-271-6426
Practice Address - Street 1:9815 CARROLL CANYON RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92131-1123
Practice Address - Country:US
Practice Address - Phone:858-831-0795
Practice Address - Fax:858-271-6426
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-29
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7920103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY726ZMedicare PIN
CACP7920AMedicare PIN