Provider Demographics
NPI:1356508089
Name:PAMESA, LUDETTE GO (LMP)
Entity Type:Individual
Prefix:
First Name:LUDETTE
Middle Name:GO
Last Name:PAMESA
Suffix:
Gender:F
Credentials:LMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10614 BEARDSLEE BLVD
Mailing Address - Street 2:STE B
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98011-3279
Mailing Address - Country:US
Mailing Address - Phone:425-486-2008
Mailing Address - Fax:425-877-1452
Practice Address - Street 1:10614 BEARDSLEE BLVD
Practice Address - Street 2:STE B
Practice Address - City:BOTHELL
Practice Address - State:WA
Practice Address - Zip Code:98011-3279
Practice Address - Country:US
Practice Address - Phone:425-486-2008
Practice Address - Fax:425-877-1452
Is Sole Proprietor?:No
Enumeration Date:2008-05-20
Last Update Date:2017-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMA00021332174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist