Healthcare Provider Details

I. General information

NPI: 1548612211
Provider Name (Legal Business Name): PAMELA BOUNKHOUNE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2016
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34,36, & 40 E MINARETS AVE
PINEDALE CA
93650-1239
US

IV. Provider business mailing address

3636 N FIRST ST 112 & 124
FRESNO CA
93726
US

V. Phone/Fax

Practice location:
  • Phone: 855-343-1057
  • Fax: 844-587-6405
Mailing address:
  • Phone: 855-343-1057
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: