Provider Demographics
NPI:1316440498
Name:HO, PAMELA DIEM CHAU (LVN)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:DIEM CHAU
Last Name:HO
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2473 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92501-2242
Mailing Address - Country:US
Mailing Address - Phone:951-682-6631
Mailing Address - Fax:951-682-6614
Practice Address - Street 1:2452 WILSHIRE ST
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92501-2144
Practice Address - Country:US
Practice Address - Phone:951-682-6631
Practice Address - Fax:951-682-6614
Is Sole Proprietor?:No
Enumeration Date:2018-03-14
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA267021164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse