MEDICARE: PAMELA GOZA-QUIROGA M.ED

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	385H00000X	Respite Care

General Provider Information

NPI Number	:	1578889333
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAMELA GOZA-QUIROGA M.ED

Provider Business Mailing Address
First Line	:	PO BOX 643
Second Line	:	1402 15TH STREET
City	:	PORT BOLIVAR
State	:	TX
Zip	:	77650
Country	:	US
Telephone Number	:	409-684-7122
Fax Number	:	409-740-3561

Provider Business Practice Location Address
First Line	:	1402 15TH STREET
Second Line	:
City	:	PORT BOLIVAR
State	:	TX
Zip	:	77650
Country	:	US
Telephone Number	:	409-684-7122
Fax Number	:	409-740-3561

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

Provider Enumeration Date	:	04/19/2010
Last Update Date	:	04/19/2010

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