Healthcare Provider Details

I. General information

NPI: 1831380930
Provider Name (Legal Business Name): PAMELYN CLOSE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/05/2007
Last Update Date: 11/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 SAN PABLO ST SUITE 1000
LOS ANGELES CA
90033-5310
US

IV. Provider business mailing address

PO BOX 31303
LOS ANGELES CA
90031-0303
US

V. Phone/Fax

Practice location:
  • Phone: 323-442-5100
  • Fax:
Mailing address:
  • Phone: 323-442-5100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2080H0002X
TaxonomyPediatric Hospice and Palliative Medicine Physician
License NumberG057580
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberG57580
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: