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NPI Code Detail

MEDICARE: PAMELA WONG NITSOS M.D.

MEDICARE: PAMELA WONG NITSOS M.D.
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
1207R00000XInternal Medicine PhysicianPN065387MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063413623
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA WONG NITSOS M.D.
Provider Business Mailing Address
First Line : 3553 WHIPPLE RD
Second Line :
City : UNION CITY
State : CA
Zip : 94587-1507
Country : US
Telephone Number : 510-454-1000
Fax Number :
Provider Business Practice Location Address
First Line : 3553 WHIPPLE RD
Second Line :
City : UNION CITY
State : CA
Zip : 94587-1507
Country : US
Telephone Number : 510-454-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/04/2005
Last Update Date : 12/13/2021

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Directions to “ PAMELA WONG NITSOS M.D.” Practice Location

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