Healthcare Provider Details

I. General information

NPI: 1912063199
Provider Name (Legal Business Name): PAMELA R. WARD CNM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 05/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9350 CAMPUS POINT DR
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8745
  • Fax: 858-657-8666
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number682334
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: