Provider Demographics
NPI:1740453059
Name:GRIFFIN, PAM (PA)
Entity type:Individual
Prefix:MRS
First Name:PAM
Middle Name:
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12818 MOLOKAI DR
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93312-8281
Mailing Address - Country:US
Mailing Address - Phone:661-496-6067
Mailing Address - Fax:
Practice Address - Street 1:5401 WHITE LN
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-6279
Practice Address - Country:US
Practice Address - Phone:661-836-4000
Practice Address - Fax:661-847-4097
Is Sole Proprietor?:No
Enumeration Date:2008-04-08
Last Update Date:2010-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA10577363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00789189OtherMEDICARE RAILROAD
CAP00789189OtherMEDICARE RAILROAD
CAAX404YMedicare PIN