Provider Demographics
NPI:1316994205
Name:VON PINNON, PAMELA (EDD, CCC-A)
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:
Last Name:VON PINNON
Suffix:
Gender:F
Credentials:EDD, CCC-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5725 WINFIELD BLVD
Mailing Address - Street 2:#3
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95123-2430
Mailing Address - Country:US
Mailing Address - Phone:408-365-5700
Mailing Address - Fax:408-365-5702
Practice Address - Street 1:1275 LINCOLN AVE
Practice Address - Street 2:#6B
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95125-3049
Practice Address - Country:US
Practice Address - Phone:408-294-0644
Practice Address - Fax:408-294-0474
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAU 417231H00000X
CAHA 989237600000X, 237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Not Answered237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter
Not Answered237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ78771ZMedicaid
CAHA 989OtherDISPENSING LICENSE #
CAAU 417OtherAUDIOLOGY LICENSE #
CAHA 989OtherDISPENSING LICENSE #