Provider Demographics
NPI:1700058674
Name:MOWER-CONNER, PAMELA (LAC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:MOWER-CONNER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4865 GLENALBYN DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-4001
Mailing Address - Country:US
Mailing Address - Phone:323-333-6232
Mailing Address - Fax:
Practice Address - Street 1:4865 GLENALBYN DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-4001
Practice Address - Country:US
Practice Address - Phone:323-333-6232
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12360171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist