Healthcare Provider Details

I. General information

NPI: 1851338875
Provider Name (Legal Business Name): PAMELA HITE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/31/2006
Last Update Date: 10/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 OLD NEWPORT BLVD SUITE102
NEWPORT BEACH CA
92663-4210
US

IV. Provider business mailing address

401 OLD NEWPORT BLVD SUITE102
NEWPORT BEACH CA
92663-4210
US

V. Phone/Fax

Practice location:
  • Phone: 949-631-0300
  • Fax: 949-631-0302
Mailing address:
  • Phone: 949-631-0300
  • Fax: 949-631-0302

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA69586
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207ND0101X
TaxonomyMOHS-Micrographic Surgery Physician
License NumberA69586
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code207NS0135X
TaxonomyProcedural Dermatology Physician
License NumberA69586
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: