Healthcare Provider Details

I. General information

NPI: 1063651867
Provider Name (Legal Business Name): PAMELA BETH FISH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2009
Last Update Date: 09/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

865 3RD AVE STE 101
CHULA VISTA CA
91911-1349
US

IV. Provider business mailing address

3880 MURPHY CANYON RD STE 200
SAN DIEGO CA
92123-4411
US

V. Phone/Fax

Practice location:
  • Phone: 619-426-7910
  • Fax: 619-426-2337
Mailing address:
  • Phone: 858-502-1135
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNPF14601
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: