Provider Demographics
NPI:1700815990
Name:O'FRIEL, PAMELA N/A (RD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:N/A
Last Name:O'FRIEL
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:N/A
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RD
Mailing Address - Street 1:PO BOX 940838
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93094-0838
Mailing Address - Country:US
Mailing Address - Phone:805-433-7777
Mailing Address - Fax:805-433-7607
Practice Address - Street 1:227 W JANSS RD
Practice Address - Street 2:SUITE 110
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-1848
Practice Address - Country:US
Practice Address - Phone:805-496-6051
Practice Address - Fax:805-496-6785
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL805535133VN1005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133VN1005XDietary & Nutritional Service ProvidersDietitian, RegisteredNutrition, Renal
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWNT805535AMedicare ID - Type UnspecifiedPROVIDER NUMBER