Provider Demographics
NPI:1265563928
Name:TWACHTMANN, PAMELA JEAN
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:JEAN
Last Name:TWACHTMANN
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:PAMELA
Other - Middle Name:T
Other - Last Name:PICKUP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAC, DIPL AC, MS
Mailing Address - Street 1:16060 VIA ESTE RD
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-8428
Mailing Address - Country:US
Mailing Address - Phone:209-532-2494
Mailing Address - Fax:209-532-3525
Practice Address - Street 1:16060 VIA ESTE RD
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-8428
Practice Address - Country:US
Practice Address - Phone:209-532-2494
Practice Address - Fax:209-532-3525
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA6616171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist