Healthcare Provider Details

I. General information

NPI: 1457513434
Provider Name (Legal Business Name): PAMELA DAVIS MCHOMBO M.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9925 INTERNATIONAL BLVD SUITE 6
OAKLAND CA
94603-2558
US

IV. Provider business mailing address

9925 INTERNATIONAL BLVD SUITE 6
OAKLAND CA
94603-2558
US

V. Phone/Fax

Practice location:
  • Phone: 510-562-3731
  • Fax: 510-562-3734
Mailing address:
  • Phone: 510-562-3731
  • Fax: 510-562-3734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 13620
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: