Provider Demographics
NPI:1336748763
Name:PAMBAKIAN, IVONNE DIANNA
Entity Type:Individual
Prefix:
First Name:IVONNE
Middle Name:DIANNA
Last Name:PAMBAKIAN
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 1:275 E HILLCREST DR STE 160-121
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5827
Mailing Address - Country:US
Mailing Address - Phone:805-208-6718
Mailing Address - Fax:
Practice Address - Street 1:275 E HILLCREST DR STE 160-121
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5827
Practice Address - Country:US
Practice Address - Phone:805-208-6718
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-17
Last Update Date:2020-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC6652440343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)