Provider Demographics
NPI:1265626345
Name:XANDRE, PAMELA EDITH (NP)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:EDITH
Last Name:XANDRE
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1629 W 17TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92706-3335
Mailing Address - Country:US
Mailing Address - Phone:714-972-2111
Mailing Address - Fax:714-972-2045
Practice Address - Street 1:1629 W 17TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92706-3335
Practice Address - Country:US
Practice Address - Phone:714-972-2111
Practice Address - Fax:714-972-2045
Is Sole Proprietor?:No
Enumeration Date:2007-08-31
Last Update Date:2007-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA465357207VH0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VH0002XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyHospice and Palliative Medicine