Provider Demographics
NPI:1295186641
Name:VITAR, PAMELA (MS LCGC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:VITAR
Suffix:
Gender:F
Credentials:MS LCGC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:CALLUM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS LCGC
Mailing Address - Street 1:11915 LA GRANGE AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5213
Mailing Address - Country:US
Mailing Address - Phone:877-743-6384
Mailing Address - Fax:
Practice Address - Street 1:11915 LA GRANGE AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5213
Practice Address - Country:US
Practice Address - Phone:877-743-6384
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-28
Last Update Date:2016-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAGC000029170300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes170300000XOther Service ProvidersGenetic Counselor, MS