Healthcare Provider Details

I. General information

NPI: 1942404629
Provider Name (Legal Business Name): PAMELA HINES MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2007
Last Update Date: 09/08/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 TELSTAR AVE
EL MONTE CA
91731-2816
US

IV. Provider business mailing address

5243 W SLAUSON AVE
LOS ANGELES CA
90056-1335
US

V. Phone/Fax

Practice location:
  • Phone: 626-569-6464
  • Fax:
Mailing address:
  • Phone: 626-569-6464
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG48889
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: