Provider Demographics
NPI:1841252533
Name:RESNIKOFF, PAMELA (MD)
Entity type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:
Last Name:RESNIKOFF
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 87729
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92138-7729
Mailing Address - Country:US
Mailing Address - Phone:619-285-5990
Mailing Address - Fax:
Practice Address - Street 1:501 WASHINGTON ST STE 725
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2241
Practice Address - Country:US
Practice Address - Phone:619-299-2570
Practice Address - Fax:619-299-2216
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-06
Last Update Date:2021-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG80358207RP1001X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G803580Medicaid
CA00G803580Medicaid
CAWG80358CMedicare ID - Type Unspecified