Provider Demographics
NPI:1710075908
Name:KANGAS, PAMELA ELIZABETH
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ELIZABETH
Last Name:KANGAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1406 MISSION ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95060-4739
Mailing Address - Country:US
Mailing Address - Phone:831-462-0341
Mailing Address - Fax:831-458-1344
Practice Address - Street 1:1406 MISSION ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-4739
Practice Address - Country:US
Practice Address - Phone:831-462-0341
Practice Address - Fax:831-458-1344
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY7392103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL7392Medicare ID - Type UnspecifiedPROVIDER NUMBER