Provider Demographics
NPI:1508961830
Name:NORMAN, PAMELA REGINA (LVN, RAS)
Entity Type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:REGINA
Last Name:NORMAN
Suffix:
Gender:F
Credentials:LVN, RAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3101 S FAIRVIEW ST
Mailing Address - Street 2:SPACE 221
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92704-6513
Mailing Address - Country:US
Mailing Address - Phone:714-834-8600
Mailing Address - Fax:714-834-8643
Practice Address - Street 1:3101 S FAIRVIEW ST
Practice Address - Street 2:SPACE 221
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92704-6513
Practice Address - Country:US
Practice Address - Phone:714-834-8600
Practice Address - Fax:714-834-8643
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAN0412300932101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)