Provider Demographics
NPI:1982611653
Name:HOWARD, PAMELA ANNE (MD, MBA, FACS, ABPN)
Entity Type:Individual
Prefix:DR
First Name:PAMELA
Middle Name:ANNE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:MD, MBA, FACS, ABPN
Other - Prefix:DR
Other - First Name:PAMELA
Other - Middle Name:ANNE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD, MBA
Mailing Address - Street 1:101 W AVENIDA VISTA HERMOSA STE 122
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-7707
Mailing Address - Country:US
Mailing Address - Phone:949-212-2699
Mailing Address - Fax:888-999-8503
Practice Address - Street 1:101 W AVENIDA VISTA HERMOSA STE 122
Practice Address - Street 2:
Practice Address - City:SAN CLEMENTE
Practice Address - State:CA
Practice Address - Zip Code:92672-7707
Practice Address - Country:US
Practice Address - Phone:949-212-2699
Practice Address - Fax:888-999-8503
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2019-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG892702084F0202X, 2084P0800X
ARE-58672084F0202X, 2084P0800X
MA2695382084F0202X, 2084P0800X
WY11699A2084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic PsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR172804001Medicaid
AR4N387Medicare PIN