1558563288 NPI number — PANAGIOTIS PETER PANAGAKIS PSY.D.

Table of content: PANAGIOTIS PETER PANAGAKIS PSY.D. (NPI 1558563288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558563288 NPI number — PANAGIOTIS PETER PANAGAKIS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANAGAKIS
Provider First Name:
PANAGIOTIS
Provider Middle Name:
PETER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANAGAKIS
Provider Other First Name:
PETER
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1558563288
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3835 N FREEWAY BLVD STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SACRAMENTO
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95834-1954
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
916-576-7900
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4220 APEX HWY STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DURHAM
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
27713-5295
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
855-501-1004
Provider Business Practice Location Address Fax Number:
866-822-7012
Provider Enumeration Date:
06/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  5188 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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