Healthcare Provider Details

I. General information

NPI: 1265563928
Provider Name (Legal Business Name): MS. PAMELA JEAN TWACHTMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PAMELA T. PICKUP LAC, DIPL. AC., MS

II. Dates (important events)

Enumeration Date: 03/07/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16060 VIA ESTE RD
SONORA CA
95370-8428
US

IV. Provider business mailing address

16060 VIA ESTE RD
SONORA CA
95370-8428
US

V. Phone/Fax

Practice location:
  • Phone: 209-532-2494
  • Fax: 209-532-3525
Mailing address:
  • Phone: 209-532-2494
  • Fax: 209-532-3525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License Number6616
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: