Provider Demographics
NPI:1538431176
Name:GANDOLFI, PAMELA JEAN
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:JEAN
Last Name:GANDOLFI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PRIMROSE ST
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-5922
Mailing Address - Country:US
Mailing Address - Phone:831-295-2908
Mailing Address - Fax:
Practice Address - Street 1:45 PRIMROSE ST
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5922
Practice Address - Country:US
Practice Address - Phone:831-295-2908
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-28
Last Update Date:2012-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide