Healthcare Provider Details

I. General information

NPI: 1891847422
Provider Name (Legal Business Name): MISS PAMELA ALEXANDRA HENDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAM ALEXANDRA HENDERSON

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1922 THE ALAMEDA
SAN JOSE CA
95126-1457
US

IV. Provider business mailing address

1922 THE ALAMEDA STE 316
SAN JOSE CA
95126-1461
US

V. Phone/Fax

Practice location:
  • Phone: 408-261-7777
  • Fax: 408-254-9960
Mailing address:
  • Phone: 408-261-7777
  • Fax: 408-254-9960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: