1457401838 NPI number — MS. PAMELA PINNELL MONTGOMERY MFT

Table of content: MS. PAMELA PINNELL MONTGOMERY MFT (NPI 1457401838)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457401838 NPI number — MS. PAMELA PINNELL MONTGOMERY MFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
PAMELA
Provider Middle Name:
PINNELL
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
MFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457401838
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2565
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SARATOGA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95070-0565
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
408-741-5657
Provider Business Mailing Address Fax Number:
408-741-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 MOORPARK AVE
Provider Second Line Business Practice Location Address:
SUITE 217
Provider Business Practice Location Address City Name:
SAN JOSE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95117-1703
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
408-741-5657
Provider Business Practice Location Address Fax Number:
408-741-5657
Provider Enumeration Date:
01/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 106H00000X , with the licence number:  MFC 38032 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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