Provider Demographics
NPI:1790761005
Name:IWASAKI, PAMELA TAKAKO (MD)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:TAKAKO
Last Name:IWASAKI
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1428 S KLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:REEDLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93654-3722
Mailing Address - Country:US
Mailing Address - Phone:559-470-7437
Mailing Address - Fax:
Practice Address - Street 1:1235 ROSE AVE
Practice Address - Street 2:
Practice Address - City:SELMA
Practice Address - State:CA
Practice Address - Zip Code:93662-3227
Practice Address - Country:US
Practice Address - Phone:559-643-0077
Practice Address - Fax:559-643-0088
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-19
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG66677207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE57865Medicare UPIN