Healthcare Provider Details

I. General information

NPI: 1366529265
Provider Name (Legal Business Name): PATRICIA POMETTO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SPECTRUM HEALTHCARE RESOURCES 12647 OLIVE BLVD
ST. LOUIS MO
63141
US

IV. Provider business mailing address

1034 LANDS END WAY
VIRGINIA BEACH VA
23451-6511
US

V. Phone/Fax

Practice location:
  • Phone: 800-325-3982
  • Fax:
Mailing address:
  • Phone: 757-477-1151
  • Fax: 866-347-0841

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110001832
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: