Provider Demographics
NPI:1578889333
Name:GOZA-QUIROGA, PAMELA (MED)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:GOZA-QUIROGA
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:
Other - Last Name:GOZA-QUIROGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 643
Mailing Address - Street 2:1402 15TH STREET
Mailing Address - City:PORT BOLIVAR
Mailing Address - State:TX
Mailing Address - Zip Code:77650
Mailing Address - Country:US
Mailing Address - Phone:409-684-7122
Mailing Address - Fax:409-740-3561
Practice Address - Street 1:1402 15TH STREET
Practice Address - Street 2:
Practice Address - City:PORT BOLIVAR
Practice Address - State:TX
Practice Address - Zip Code:77650
Practice Address - Country:US
Practice Address - Phone:409-684-7122
Practice Address - Fax:409-740-3561
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-19
Last Update Date:2010-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care