Provider Demographics
NPI:1467679241
Name:MARTIN, PAMELA TZU (LAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:TZU
Last Name:MARTIN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:TZU
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC
Mailing Address - Street 1:2654 FLOWER FIELDS WAY
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92010-8330
Mailing Address - Country:US
Mailing Address - Phone:760-470-1189
Mailing Address - Fax:
Practice Address - Street 1:6494 FAIRWATER PL
Practice Address - Street 2:
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92011-4028
Practice Address - Country:US
Practice Address - Phone:760-470-1189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11337171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist