Provider Demographics
NPI:1366813727
Name:GOMBE, PAMELA FARISAI
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:FARISAI
Last Name:GOMBE
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 1:8 CAPTAIN DR
Mailing Address - Street 2:553
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-1744
Mailing Address - Country:US
Mailing Address - Phone:972-742-5746
Mailing Address - Fax:
Practice Address - Street 1:8 CAPTAIN DR
Practice Address - Street 2:553
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-1744
Practice Address - Country:US
Practice Address - Phone:972-742-5746
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-12
Last Update Date:2015-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA674557163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse