Healthcare Provider Details

I. General information

NPI: 1760339865
Provider Name (Legal Business Name): REBECCA PANMAN PPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2026
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 TEMPLE AVE
CAMARILLO CA
93010-4835
US

IV. Provider business mailing address

3535 VILLAGE AT THE PARK DR
CAMARILLO CA
93012-7788
US

V. Phone/Fax

Practice location:
  • Phone: 805-383-5350
  • Fax:
Mailing address:
  • Phone: 805-383-5350
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number250097907
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: