Stella Panos Phd A Professional Psychology Corporation | |
720 Wilshire Blvd Ste 204 Santa Monica CA 90401-1737 | |
(424) 345-6377 | |
Not Available |
Full Name | Stella Panos Phd A Professional Psychology Corporation |
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Speciality | Clinical Neuropsychologist |
Location | 720 Wilshire Blvd Ste 204, Santa Monica, California |
Authorized Official Name and Position | Stella Panos (PRESIDENT) |
Authorized Official Contact | 4243456377 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Stella Panos Phd A Professional Psychology Corporation 8967 Cadillac Ave Los Angeles CA 90034-2056 Ph: (562) 964-1906 | Stella Panos Phd A Professional Psychology Corporation 720 Wilshire Blvd Ste 204 Santa Monica CA 90401-1737 Ph: (424) 345-6377 |
NPI Number | 1962223230 |
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Provider Enumeration Date | 10/21/2024 |
Last Update Date | 10/21/2024 |
Certification Date | 10/20/2024 |
Medicare PECOS PAC ID | 1355877804 |
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Medicare Enrollment ID | O20241209001082 |
Identifier | Type | State | Issuer |
---|---|---|---|
1962223230 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
103TC0700X | Psychologist - Clinical | (* (Not Available)) | Secondary |
Provider Name | Stella E Panos |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1104252352 PECOS PAC ID: 3779713375 Enrollment ID: I20140227000487 |
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