Healthcare Provider Details

I. General information

NPI: 1962420422
Provider Name (Legal Business Name): PAMELA ANN CAPRIOLI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA ANN FORMELLA-FARRER PA

II. Dates (important events)

Enumeration Date: 07/17/2006
Last Update Date: 08/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9500 STOCKDALE HWY SUITE 203
BAKERSFIELD CA
93311-3620
US

IV. Provider business mailing address

PO BOX 1139 SUITE 203
BAKERSFIELD CA
93302-1139
US

V. Phone/Fax

Practice location:
  • Phone: 661-587-8110
  • Fax: 661-587-8220
Mailing address:
  • Phone: 661-371-2796
  • Fax: 661-438-1746

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: