1023024106 NPI number — MRS. PAMELA B BURGESS AUDIOLOGIST

Table of content: MRS. PAMELA B BURGESS AUDIOLOGIST (NPI 1023024106)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023024106 NPI number — MRS. PAMELA B BURGESS AUDIOLOGIST

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BURGESS
Provider First Name:
PAMELA
Provider Middle Name:
B
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AUDIOLOGIST
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PHELPS
Provider Other First Name:
PAMELA
Provider Other Middle Name:
B
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
AUDIOLOGIST
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1023024106
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2125 S BROADWAY STE 111
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA MARIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93454-7835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-922-2884
Provider Business Mailing Address Fax Number:
805-922-2844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2125 S BROADWAY STE 111
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANTA MARIA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93454-7835
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-922-2884
Provider Business Practice Location Address Fax Number:
805-922-2844
Provider Enumeration Date:
07/31/2006

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: 237700000X , with the licence number:  DAU3118 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: AU3118 , 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)