Provider Demographics
NPI:1508836289
Name:KENNEY, PAMELA LOUISE (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:LOUISE
Last Name:KENNEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:644 NAPLES ST
Mailing Address - Street 2:
Mailing Address - City:CHULA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:91911-1636
Mailing Address - Country:US
Mailing Address - Phone:619-744-5355
Mailing Address - Fax:
Practice Address - Street 1:644 NAPLES ST
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91911-1636
Practice Address - Country:US
Practice Address - Phone:619-744-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA96485207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine