Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | PT33328 | CA |
NPI | 1639221872 |
---|---|
Provider Name | Pamela Campbell Downs |
First Address | Santa Ana, CA 92704-7909 |
Second Address | Santa Ana, CA 92704-7909 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/01/2007 |
Last Update Date | 12/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
PT33328 | LICENSE # (01) | CA |