Healthcare Provider Details

I. General information

NPI: 1790761005
Provider Name (Legal Business Name): PAMELA TAKAKO IWASAKI M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1235 ROSE AVE
SELMA CA
93662-3227
US

IV. Provider business mailing address

1428 S KLEIN AVE
REEDLEY CA
93654-3722
US

V. Phone/Fax

Practice location:
  • Phone: 559-643-0077
  • Fax: 559-643-0088
Mailing address:
  • Phone: 559-470-7437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG66677
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: