Provider Demographics
NPI:1417916107
Name:ATIENZA, PAMELA VELASCO (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:VELASCO
Last Name:ATIENZA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:890 EASTLAKE PARKWAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91914
Mailing Address - Country:US
Mailing Address - Phone:619-656-6817
Mailing Address - Fax:619-656-6908
Practice Address - Street 1:890 EASTLAKE PARKWAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91914
Practice Address - Country:US
Practice Address - Phone:619-656-6817
Practice Address - Fax:619-656-6908
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA 64995208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics