Provider Demographics
NPI:1306022892
Name:PAMATMAT, ANNAROSE VILLAMINO (NP)
Entity Type:Individual
Prefix:
First Name:ANNAROSE
Middle Name:VILLAMINO
Last Name:PAMATMAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ANNAROSE
Other - Middle Name:VILLAMINO
Other - Last Name:BALANON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 PASTEUR DR
Mailing Address - Street 2:
Mailing Address - City:STANFORD
Mailing Address - State:CA
Mailing Address - Zip Code:94305-2200
Mailing Address - Country:US
Mailing Address - Phone:650-723-4000
Mailing Address - Fax:847-570-1248
Practice Address - Street 1:300 PASTEUR DR
Practice Address - Street 2:
Practice Address - City:STANFORD
Practice Address - State:CA
Practice Address - Zip Code:94305-2200
Practice Address - Country:US
Practice Address - Phone:650-723-4000
Practice Address - Fax:847-570-1248
Is Sole Proprietor?:No
Enumeration Date:2008-01-14
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL209-006573OtherIL STATE LIC