Healthcare Provider Details

I. General information

NPI: 1184015133
Provider Name (Legal Business Name): PAMELA HUGHES NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4440 BROCKTON AVE SUITE 420
RIVERSIDE CA
92501-4068
US

IV. Provider business mailing address

29654 DUNKIRK ST
SUN CITY CA
92586-3410
US

V. Phone/Fax

Practice location:
  • Phone: 951-684-8020
  • Fax: 951-684-8090
Mailing address:
  • Phone: 951-684-8020
  • Fax: 951-684-8090

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License NumberNP95001402
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: