Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225XM0800X | Mental Health | OT1255 | CA |
NPI | 1942602339 |
---|---|
Provider Name | Pamela Nail |
First Address | Watsonville, CA 95076 |
Second Address | Watsonville, CA 95076 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2014 |
Last Update Date | 17/09/2014 |