Provider Demographics
NPI:1013111210
Name:BOHN, PAMELA SUMMIT (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:SUMMIT
Last Name:BOHN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:HONEY
Other - Last Name:SUMMIT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:12300 WILSHIRE BLVD.
Mailing Address - Street 2:SUITE 330
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-1057
Mailing Address - Country:US
Mailing Address - Phone:310-442-5905
Mailing Address - Fax:310-820-7518
Practice Address - Street 1:12300 WILSHIRE BLVD.
Practice Address - Street 2:SUITE 330
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-1057
Practice Address - Country:US
Practice Address - Phone:310-442-5905
Practice Address - Fax:310-820-7518
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG 590672084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry