Provider Demographics
NPI:1861115016
Name:FUNDERBURK, PAMELA D
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:FUNDERBURK
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 1:337 W QUEEN ST APT 8
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-5148
Mailing Address - Country:US
Mailing Address - Phone:310-590-0006
Mailing Address - Fax:
Practice Address - Street 1:337 W QUEEN ST APT 8
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-5148
Practice Address - Country:US
Practice Address - Phone:310-590-0006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-22
Last Update Date:2022-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist