Healthcare Provider Details

I. General information

NPI: 1639878036
Provider Name (Legal Business Name): PAMELA OREBAUGH MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2023
Last Update Date: 02/24/2023
Certification Date: 02/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 FAIRVIEW LN
SONORA CA
95370-4809
US

IV. Provider business mailing address

20039 MALLARD CIR
SONORA CA
95370-9396
US

V. Phone/Fax

Practice location:
  • Phone: 209-536-2000
  • Fax:
Mailing address:
  • Phone: 510-589-1102
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number113318
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: