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General NPI Number Information
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NPI Number | 1487882874
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Entity Type | Individual
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Provider Name | PAMELA KANDANKULAM PLANTHARA PSY.D
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Gender | Female
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Dates
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Enumeration Date | 06/24/2009
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Last Update Date | 10/01/2014
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Provider Practice Location Address
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Address Line | 525 21ST ST DEPARTMENT OF VETERAN AFFAIRS
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City | OAKLAND
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State | CA
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Zip | 94612-1605
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Country | US
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Telephone | 510-587-3494
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Fax |
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Provider Business Mailing Address
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Address Line | 525 21ST ST
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City | OAKLAND
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State | CA
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Zip | 94612-1605
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Country | US
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Telephone | 510-587-3494
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015991
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License Number State | NY
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