Provider Demographics
NPI:1962420422
Name:CAPRIOLI, PAMELA ANN (PA)
Entity type:Individual
Prefix:MS
First Name:PAMELA
Middle Name:ANN
Last Name:CAPRIOLI
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:PAMELA
Other - Middle Name:ANN
Other - Last Name:FORMELLA-FARRER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 1139
Mailing Address - Street 2:SUITE 203
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93302-1139
Mailing Address - Country:US
Mailing Address - Phone:661-371-2796
Mailing Address - Fax:661-438-1746
Practice Address - Street 1:9500 STOCKDALE HWY
Practice Address - Street 2:SUITE 203
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-3620
Practice Address - Country:US
Practice Address - Phone:661-587-8110
Practice Address - Fax:661-587-8220
Is Sole Proprietor?:No
Enumeration Date:2006-07-17
Last Update Date:2016-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13751363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P39456Medicare UPIN
CA00PA137510Medicare ID - Type Unspecified