MEDICARE: PAMELA NOONAN RD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363L00000X	Nurse Practitioner	NP95036904	CA
2	133V00000X	Registered Dietitian	860640	CA
3	133N00000X	Nutritionist	860640	CA

General Provider Information

NPI Number	:	1043260896
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA NOONAN RD

Provider Business Mailing Address
First Line	:	600 COFFEE RD
Second Line	:
City	:	MODESTO
State	:	CA
Zip	:	95355-4201
Country	:	US
Telephone Number	:	209-524-1211
Fax Number	:

Provider Business Practice Location Address
First Line	:	2100 POWELL ST
Second Line	:
City	:	EMERYVILLE
State	:	CA
Zip	:	94608-1826
Country	:	US
Telephone Number	:	510-350-2600
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2006
Last Update Date	:	11/30/2025

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Directions to “ PAMELA NOONAN RD” Practice Location

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