Healthcare Provider Details

I. General information

NPI: 1639221872
Provider Name (Legal Business Name): PAMELA CAMPBELL DOWNS P.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA LYNN CAMPBELL

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3601 S HARBOR BLVD # 150
SANTA ANA CA
92704-7909
US

IV. Provider business mailing address

3601 S HARBOR BLVD # 150
SANTA ANA CA
92704-7909
US

V. Phone/Fax

Practice location:
  • Phone: 714-428-3520
  • Fax: 714-748-7622
Mailing address:
  • Phone: 714-428-3520
  • Fax: 714-748-7622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License NumberPT33328
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: