Basic Information
| Provider Information | |||||||||
| NPI: | 1801074117 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PAVLAT | ||||||||
| FirstName: | JAMIE | ||||||||
| MiddleName: | MARIE | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | ARDMS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1227 W 17TH ST STE 101 | ||||||||
| Address2: | STE101 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927063458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145000340 | ||||||||
| FaxNumber: | 7145000341 | ||||||||
| Practice Location | |||||||||
| Address1: | 1227 W 17TH ST STE 101 | ||||||||
| Address2: | STE101 | ||||||||
| City: | SANTA ANA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 927063458 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7145000340 | ||||||||
| FaxNumber: | 7145000341 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2008 | ||||||||
| LastUpdateDate: | 02/08/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471S1302X | 20892 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Sonography |
No ID Information.