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General NPI Number Information
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NPI Number | 1487904397
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Entity Type | Individual
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Provider Name | PAMELA ELIZABETH MIKITA PTA
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Gender | Female
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Dates
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Enumeration Date | 09/18/2012
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 2486 N PONDEROSA DR
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City | CAMARILLO
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State | CA
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Zip | 93010-2376
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Country | US
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Telephone | 805-484-5447
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Fax | 805-484-2158
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Provider Business Mailing Address
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Address Line | 2486 N PONDEROSA DR
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City | CAMARILLO
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State | CA
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Zip | 93010-2376
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Country | US
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Telephone | 805-484-5447
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Fax | 805-484-2158
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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 | 225200000X
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Taxonomy Name | Physical Therapy Assistant
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License Number | AT 4438
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License Number State | CA
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