Healthcare Provider Details

I. General information

NPI: 1003670233
Provider Name (Legal Business Name): PAM HAINES PAIGE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2024
Last Update Date: 02/08/2024
Certification Date: 02/06/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 7TH STREET, SUITE 301
SANTA MONICA CA
90401
US

IV. Provider business mailing address

10573 W PICO BLVD STE 156
LOS ANGELES CA
90064-2333
US

V. Phone/Fax

Practice location:
  • Phone: 310-395-0454
  • Fax:
Mailing address:
  • Phone: 310-395-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5573
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: