Provider Demographics
NPI:1689634974
Name:DAVIS, PAMELA D (MD)
Entity Type:Individual
Prefix:MISS
First Name:PAMELA
Middle Name:D
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:133 N. PRAIRIE AVE.
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4878
Mailing Address - Country:US
Mailing Address - Phone:310-419-0900
Mailing Address - Fax:310-622-8776
Practice Address - Street 1:133 N. PRAIRIE AVE.
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4878
Practice Address - Country:US
Practice Address - Phone:310-419-0900
Practice Address - Fax:310-622-8776
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-23
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46258207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G462580Medicaid
CA00G462580Medicaid