MEDICARE: PAMELA MARY SAKAMOTO BSN, PHN

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	163WC1500X	Community Health Registered Nurse	272783	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	272783	OTHER	CA	RN LICENSE NUMBER

General Provider Information

NPI Number	:	1578620241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA MARY SAKAMOTO BSN, PHN

Provider Business Mailing Address
First Line	:	7621 WOODCHUCK WAY
Second Line	:
City	:	CITRUS HEIGHTS
State	:	CA
Zip	:	95610-2533
Country	:	US
Telephone Number	:	916-600-9015
Fax Number	:	916-723-9265

Provider Business Practice Location Address
First Line	:	275 BECK AVE
Second Line	:
City	:	FAIRFIELD
State	:	CA
Zip	:	94533-6804
Country	:	US
Telephone Number	:	707-784-8654
Fax Number	:	707-421-7484

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

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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