Healthcare Provider Details

I. General information

NPI: 1093957367
Provider Name (Legal Business Name): MS. PAMELA HAWARA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2009
Last Update Date: 04/01/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15350 NORDHOFF ST.
NORTH HILLS CA
91343
US

IV. Provider business mailing address

15518 LIVE OAK SPRINGS CANYON RD
CANYON COUNTRY CA
91387-4701
US

V. Phone/Fax

Practice location:
  • Phone: 818-672-8228
  • Fax:
Mailing address:
  • Phone: 661-839-3966
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code126800000X
TaxonomyDental Assistant
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: