Healthcare Provider Details

I. General information

NPI: 1700083425
Provider Name (Legal Business Name): PAMELA ENO MOONEY R.N.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/27/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2315 STOCKTON BLVD RM 4302 PATIENT CARE SERVICES UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817
US

IV. Provider business mailing address

2315 STOCKTON BLVD RM 4302 PATIENT CARE SERVICES UC DAVIS MEDICAL CENTER
SACRAMENTO CA
95817
US

V. Phone/Fax

Practice location:
  • Phone: 916-703-3023
  • Fax:
Mailing address:
  • Phone: 916-703-3023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberRN 265096
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: