Individual
PAMELA MODESTE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RDT, MS
Contact information
Practice address
1073 N ALMA AVE, LOS ANGELES, CA 90063-2731
(213) 422-1393
Mailing address
1001 WILSHIRE BLVD STE 2177, LOS ANGELES, CA 90017-2415
(213) 422-1393
Taxonomy
Speciality
Code
Description
License number
State
101200000X
Drama Therapist
Primary
686
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
686
NADTA
—
Enumeration date
01/20/2022
Last updated
01/20/2022
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