Provider Demographics
NPI:1427038553
Name:KURTZHALS, PAMELA L (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:L
Last Name:KURTZHALS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:L
Other - Last Name:KURTZHALS BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 33865
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92163-3865
Mailing Address - Country:US
Mailing Address - Phone:858-888-7700
Mailing Address - Fax:
Practice Address - Street 1:894 ROSEBERRY DR
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89138-7559
Practice Address - Country:US
Practice Address - Phone:619-962-6868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2023-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75524208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV19080Medicaid
CA00A755240Medicaid
CAWA75524BMedicare ID - Type UnspecifiedGROUP# W7168
CA00A755240Medicaid