Healthcare Provider Details

I. General information

NPI: 1558370171
Provider Name (Legal Business Name): PAMELA A. LAROCHELLE PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/05/2006
Last Update Date: 07/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

130 SAWDUST RD
SPRING TX
77380-2272
US

IV. Provider business mailing address

9 GREENWAY PLZ SUITE 2950
HOUSTON TX
77046-0905
US

V. Phone/Fax

Practice location:
  • Phone: 281-419-3162
  • Fax:
Mailing address:
  • Phone: 866-607-7334
  • Fax: 713-358-4801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA04472
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: