Healthcare Provider Details

I. General information

NPI: 1780210039
Provider Name (Legal Business Name): SHOSHANA PANITZ AGPCNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHOSHANA STONE

II. Dates (important events)

Enumeration Date: 03/19/2020
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17875 VON KARMAN AVE STE 150
IRVINE CA
92614-6212
US

IV. Provider business mailing address

12512 CHANDLER BLVD APT 118
VALLEY VILLAGE CA
91607-1971
US

V. Phone/Fax

Practice location:
  • Phone: 617-334-5441
  • Fax:
Mailing address:
  • Phone: 323-979-6694
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95012859
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95012859
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: