1992936678 NPI number — ANGELIKA PANOVA MHPNP-RN/ LMFT

Table of content: ANGELIKA PANOVA MHPNP-RN/ LMFT (NPI 1992936678)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992936678 NPI number — ANGELIKA PANOVA MHPNP-RN/ LMFT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PANOVA
Provider First Name:
ANGELIKA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MHPNP-RN/ LMFT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PANOVA BOHANNAN
Provider Other First Name:
ANGELIKA
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MHPNP-RN/ LMFT
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1992936678
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1057 E IMPERIAL HWY
Provider Second Line Business Mailing Address:
APT 226
Provider Business Mailing Address City Name:
PLACENTIA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92870-1717
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-215-0881
Provider Business Mailing Address Fax Number:
951-215-0881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2030 E. 4TH ST.
Provider Second Line Business Practice Location Address:
STE. 140-F
Provider Business Practice Location Address City Name:
SANTA ANA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92705-3969
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
714-887-3816
Provider Business Practice Location Address Fax Number:
951-215-0881
Provider Enumeration Date:
07/29/2009

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: 363LP0808X , with the licence number:  95004867 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 106H00000X , with the licence number: 49586 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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