Provider Demographics
NPI:1326179037
Name:SIROTA, PAM
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:
Last Name:SIROTA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9108 W 25TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-1904
Mailing Address - Country:US
Mailing Address - Phone:310-720-1658
Mailing Address - Fax:310-838-5897
Practice Address - Street 1:9108 W 25TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-1904
Practice Address - Country:US
Practice Address - Phone:310-720-1658
Practice Address - Fax:310-838-5897
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC42680106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist