Petersen, Pamela O
Petersen, Pamela O is an individual health care provider with primary practice located at 2330 W Covell Blvd , Davis CA 95616-5658. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Petersen, Pamela O can be contacted via phone (530) 756-2364.Contact Information
Primary practice address
2330 W Covell Blvd
Davis CA 95616-5658
Phone: (530) 756-2364
Fax: (530) 756-5817
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | A49282 | California |
Profile Details
| NPI number | 1255430716 |
|---|---|
| LBN Legal business name | Petersen, Pamela O |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Sep 21st, 2006 |
| Last updated | May 6th, 2008 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1255430716 | NPPES |
| California | MEDICAID | 00A492820 | |
| California | Other | 00A492820 |
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