Healthcare Provider Details

I. General information

NPI: 1902859283
Provider Name (Legal Business Name): PAM WARREN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAM HOLMAN MD

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1702 ESPLANADE
CHICO CA
95926-3315
US

IV. Provider business mailing address

1702 ESPLANADE
CHICO CA
95926-3315
US

V. Phone/Fax

Practice location:
  • Phone: 530-898-0504
  • Fax: 530-898-9647
Mailing address:
  • Phone: 530-898-0504
  • Fax: 530-898-9647

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number0101046619
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: