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NPI Code Detail

MEDICARE: MS. PAMELA JEAN DIAS NURSE PRACTITIONER

MEDICARE: MS. PAMELA JEAN DIAS NURSE PRACTITIONER
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
1363LF0000XFamily Nurse Practitioner219713CA

General Provider Information

NPI Number : 1174514822
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. PAMELA JEAN DIAS NURSE PRACTITIONER
Provider Business Mailing Address
First Line : 7373 WEST LN
Second Line :
City : STOCKTON
State : CA
Zip : 95210-3377
Country : US
Telephone Number : 209-476-5405
Fax Number : 209-476-3708
Provider Business Practice Location Address
First Line : 7373 WEST LN
Second Line :
City : STOCKTON
State : CA
Zip : 95210-3377
Country : US
Telephone Number : 209-476-5405
Fax Number : 209-476-3708
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/02/2005
Last Update Date : 07/31/2013

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