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NPI Code Detail

MEDICARE: PAMELA CHAYAVICHITSILP MD

MEDICARE: PAMELA CHAYAVICHITSILP MD
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
1207N00000XDermatology PhysicianA115300CA

General Provider Information

NPI Number : 1588898811
Entity Type Code : Individual
Provider Name (Legal Business Name) : PAMELA CHAYAVICHITSILP MD
Provider Business Mailing Address
First Line : 8899 UNIVERSITY CENTER LN STE 350
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122-1010
Country : US
Telephone Number : 510-333-9374
Fax Number :
Provider Business Practice Location Address
First Line : 8899 UNIVERSITY CENTER LN STE 350
Second Line :
City : SAN DIEGO
State : CA
Zip : 92122-1010
Country : US
Telephone Number : 510-333-9374
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2009
Last Update Date : 06/13/2013

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