Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2081S0010X | Sports Medicine | PT297049 | CA |
Y | 213ES0000X | Sports Medicine | PT297049 | CA |
NPI | 1124677745 |
---|---|
Provider Name | Pamela Christine Marchese |
First Address | Los Gatos, CA 95032-7645 |
Second Address | Los Gatos, CA 95032-7645 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/09/2019 |
Last Update Date | 06/09/2019 |